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Full text of "The 1960 Annual Report of the Children's Hospital Medical Center"



The Children's Hospital Medical Center 







The 196 



Report 



THE CHILDREN'S HOSPITAL MEDICAL CENTER, BOSTON 

comprising: 

The Children's Hospital 

Infants' Hospital 

The House of the Good Samaritan 

Sarah Fuller Foundation for Little Deaf Children 

Sharon Sanatorium 

The Hospital and Convalescent Home for Children 

Charitable Surgical Appliance Shop 

and affiliates: 

Children's Cancer Research Foundation, Inc. 

Judge Baker Guidance Center 

Children's Mission to Children 



of the Children's Hospital Medical Center 




THE CHILDREN'S HOSPITAL MEDICAL CENTER 



OFFICERS, BOARD OF TRUSTEES 



William W. Wolbach 

PRESIDENT 

G. Peabody Gardner 

VICE PRESIDENT 

Alexander Wheeler 
VICE PRESIDENT 

F. Murray Forbes, Jr. 

TREASURER 

Arnold W. Hunnewell 

SECRETARY AND ASSISTANT TREASURER 

Mrs. David Wilder 

CHAIRMAN, WOMEN'S COMMITTEE 

Nelson S. Bartlett, Jr. 
ASSISTANT TREASURER 



Director 

Joseph P. Greer 



Chiefs of Staff 

Sidney Farber, M.D. 

PATHOLOGIST-IN-CHIEF 

George E. Gardner, M.D. 

PSYCHIATRIST-IN-CHIEF 

William T. Green, M.D. 

ORTHOPEDIC SURGEON-IN-CHIEF 

Robert E. Gross, M.D. 

SURGEON-IN-CHIEF 

Franc D. Ingraham, M.D. 
NEUROSURGEON-IN-CHIEF 

Charles A. Janeway, M.D. 

PHYSICIAN-IN-CHIEF 

Edward B. D. Neuhauser, M.D. 
RADIOLOGIST-IN-CHIEF 



COUNSEL 

William N. Swift 

AUDITOR 

Arthur Andersen 

ASSISTANT SECRETARY OF THE BOARD 

Miss Antoinette J. Valcnza 



THE CHILDREN'S HOSPITAL MEDICAL CENTER 



ADMINISTRATIVE STAFF, 1960 



Director: 

Joseph P. Greer 

Assistant Directors: 

Lendon Snedeker, M. D., 

FOR PROFESSIONAL SERVICES 



Muriel B. Vesey, R. N., 

FOR NURSING SERVICE 
AND SCHOOL OF NURSING 



Greer Williams, 

FOR DEVELOPMENT AND PUBLIC RELATIONS 



COMPTROLLER: 

Richard E. Held, C. P. A. 

FUND DIRECTOR: 

Mrs. Anthony T. Michaels 

ADMINISTRATIVE ASSISTANT: 

Rudman Ham 



'Deceased 



Administrative Department Heads 

Alexander T. Brown, 

PERSONNEL DIRECTOR 

Salvatore Caliguri, 

SUPERVISOR, PRINT SHOP 

Miss Shirley Cogland, 

DIRECTOR, PHYSICAL THERAPY DEPARTMENT 

Frank W. Dickey, 

EXECUTIVE HOUSEKEEPER 

Miss Ellen Fitzgerald, 

PURCHASING AGENT 

Mrs. Harriet H. Gibney, 

DIRECTOR, PUBLIC INFORMATION 

John Glancy, 

MANAGER, SURGICAL APPLIANCE SHOP 

Miss Marion W. Hall,* 

DIRECTOR OF SOCIAL SERVICE 

F. R. Harding, 

DIRECTOR, VISUAL EDUCATION DEPARTMENT 

Mrs. Kathleen Higgins, 

DIRECTOR, VOLUNTEER SERVICE 

Miss Marcelle Hocquet, 

SUPERVISOR, DEPARTMENT OF 
PATIENT EDUCATION AND RECREATION 

Miss Hester E. Macuen, R. N., 

DIRECTOR, EMPLOYEE HEALTH SERVICE 

George T. Nicoll, 

DIRECTOR, SPECIAL SERVICES 

Mrs. Ruth C. O'Brien, 

CHIEF OPERATOR 

Miss Dorothy Pratt, R. N., 

SUPERVISOR, OUT-PATIENT DEPARTMENT 

Miss Dorothy Rutherford, 

SECRETARY, WOMEN'S COMMITTEE 

Mrs. Marie Smith, R. R. L., 

DIRECTOR, MEDICAL RECORDS DEPARTMENT 

Arthur Stomberg, 

PLANT SUPERINTENDENT 

Mrs. Martha Stuart, 

HEAD DIETICIAN 

Arthur M. Thompson, 
CHIEF PHARMACIST 




PRESIDENT'S MESSAGE 

Large voluntary hospitals engaged in teaching and research as well 
as care of patients, such as The Children's Hospital Medical Center, 
present complex problems of administration. These problems appear 
to rise largely from two factors: 

1. Such institutions operate not for profit but as a service to the 
community and to humanity in general; because the need for service 
is prone to outrun available capital and income, these hospitals are 
constantly in, or on the verge of, financial crises. Each improvement 
in the quality or quantity of service is made at the risk of an unbalanced 
budget and further deficit. The twin obligation to provide service to 
patients and their families, most of it at less than cost, and yet to 
balance the budget presents a paradox alien to the philosophy of the 
business man who finds the service he renders no substitute for a profit 
if he wishes to continue in business. We have touched here on the 
essential although not fully recognized difference between business and 
charity. As Mr. Greer indicates in the Director's Report, in a hospital 
service is profit, but it still remains to be underwritten by whoever 
can afford the dollar loss. 

2. A voluntary hospital such as ours may present an anomaly 
of leadership and organization: dual management. This is to say it is 
legally governed by a lay board to whom the Director is presumed to 
be responsible for efficient operation of the hospital; yet the hospital's 
professional staff is legally autonomous and therefore to a great extent 
self-governing in its practice of medicine within the hospital. Successful 
management therefore depends not so much on the delegation of 
authority in a straight line of command from board to the staff as on 
a spirit of mutual respect and good will. It may come as something 
of a surprise to the uninitiated hospital trustee to find that the Director 
himself is not finally responsible to the board for operation of the 
hospital; rather, it is the professional staff which ultimately decides how 
they and therefore the hospital can best serve their patients. Conse- 
quently, in the operation of a large voluntary hospital, the Director 
must understand and try to implement the principles of sound business 
management and yet serve less as an executor of the board's will than 



as an ambassador between the board and the professional staff, which 
has a well-defined will of its own. 

It is in the image of a modern diplomat, who frequently must live 
with crisis, endeavoring to carry out the policy of his government 
through continuous representation and negotiation, that we might best 
think of the position of Director of The Children's Hospital Medical 
Center as we read the Director's Report, in the pages following. For 
my part, I find both vision and realism, the ideal and the practical, 
expressed here in the most challenging communication to come to the 
Board from the Hospital during my experience as Trustee and President. 
Here we find understanding not only of the changing needs of children 
and of The Children's Hospital, but pleasant news that our operating 
deficit has been reduced by one third in Mr. Greer's second year as 
Director. Here we find not only clear appreciation of the role of the 
Trustees and of the growing group of our friends in their support of 
the Hospital and the Medical Center, but we also get a frank request for 
an even greater effort on our part to strengthen the institution's mission 
as one of the greater educational and scientific arms of Harvard Medical 
School. 

Perhaps we have not been able to extend these efforts and meet 
the future as rapidly and progressively as we might, but in 1960 we 
made some progress. And we have made this progress, as indicated above, 
in one of the most difficult of all areas: hospital administration. 

In injecting this particular emphasis in the President's Message, I 
do not think anyone will assume that I have overlooked what is and 
always has been the secret of our success as a world center of pediatrics. 
The need of a child for good health is continuous from infancy through 
adolescence; as long as our doctors, nurses, social workers, technicians, 
and the many others among our 1,400 employees work to meet this need, 
the tremendous vitality, energy, and creativity of our institution will 
be self-renewing. Its objectives are clear and the means will be found. 



William W. Wolbach, President 




TREASURER'S REPORT 

The most gratifying feature of the year's financial transactions was 
the substantial decrease in the deficit. As shown in the comparative 
statement of income, the net loss of $275,000 for the fiscal year ended 
September 30, 1960 was $310,000 less than the 1959 deficit of $585,000; 
both figures being exclusive of depreciation. 

The improvement in operating results in 1960 compared to 1959 
is chiefly due to the following increases in revenue: 
Patient revenue $379,000 

Income from investments 86,000 

Allotments from our 

affiliated institutions 75,000 

$540,000 
The increased revenue more than offsets the rise in operating costs 
of $248,000. Although active steps were taken during the year to 
control costs through budgets, this increase was attributable to salary 
and wage increases granted during the year. 

The favorable change in gross patient revenue is due to an increase 
both in rates and in use of Hospital services. Inpatient rates were 
raised $1 per day effective January 1, 1960 and outpatient rates were 
raised $1 per visit on April 4, 1960. The increase in the use of the 
Hospital is shown in the following comparative operating statistics: 

Fiscal Year 

Admissions 
Patient days 
Average daily census 
Outpatient visits 

excluding psychiatry 
Emergency visits included 21,924 
Services: 

Laboratory tests 
X-rays 
Operations 

On December 1, 1959, in accordance with Chapter 283 of the 
Acts of 1959, the following institutions: The Children's Hospital, The 
Children's Medical Center, Inc. and Charitable Surgical Appliance Shop 
merged into one body known as the children's hospital medical 
center. The statement of income shown on the following page reflects 
the operations for both fiscal years 1960 and 1959 of these institutions: 
The Children's Hospital, Infants' Hospital, Sharon Sanatorium, Hospital 
and Convalescent Home for Children, and Association of the House 
of the Good Samaritan. 

F. Murray Forbes, Jr., Treasurer 



1960 


1959 


9,924 


9,919 


93,024 


91,399 


254 


250 


87,245 


86,901 


21,924 


19,845 


126,208 


118,642 


78,248 


74,453 


5,616 


5,492 



7 

THE CHILDREN'S HOSPITAL MEDICAL CENTER 

Comparative Statement of Income for the Years Ended September 30, 1960 and 1959 

I960 1959 

During the year we earned from patient care $4,864,579 $4,485,153 

But the amounts not received because of allowances and patients' 

inability to pay were 604,393 580,019 

Net revenue from services to patients $4,260,186 $3,905,134 

We received other operating revenue from: 

Meals, rentals, services, School of Nursing $ 361,107 $ 300,947 

Overhead allowance on research grants 100,528 77,425 

Outside grants for research and education 1,706,701 2,168,336 1,746,759 2,125,131 

TOTAL OPERATING REVENUE ' $6,428,522 ~ $6,030,265 

We spent or incurred expenditures for patient care: 
Salaries, supplies and expenses from: 

General funds $6,028,662 $5,740,817 

Outside grants for research and education 1,706,701 1,746,759 

TOTAL COST OF OPERATING THE HOSPITAL 7,735,363 7,487,576 

Since operating revenue did nor equal operating costs, the resulting 

LOSS from operation of the Hospital was $1,306,841 $1,457,311 

This loss was partially defrayed by income received from these sources: 

United Community Services allotment $ 31,257 $ 35,040 

Committee of the Permanent Charity Fund 14,000 12,000 

Income from investments and trust funds 715,611 629,258 

Allotments from affiliated institutions 270,724 1,031,592 195,235 871,533 

Net LOSS before depreciation $ 275,249 $ 585,778 

Depreciation 370,300 358,828 

Net LOSS for year ended September 30 charged against the General Fund $ 645,549 $ 944,606 

During the year we also received: 

Legacies for general purposes $ 484,885 $ 906,608 

Gifts and legacies for restricted endowment 138,261 323,964 

The statement of income for the year ended September 30, I960 has been condensed from a report certified to by Arthur Andersen & Co. 




/ I j^f 





"... the need for our chief products — 
pediatricians, pediatric nurses, and pediatric 
knowledge has increased ..." 




DIRECTOR'S REPORT 

Changing Needs of Children 

Children, it has been remarked, are not ordinarily aware of change. 
While, if granted good health, they grow physically and develop men- 
tally day by day, the world around them appears to them constant, 
everlasting. But we who are adults and assume responsibility for children 
— their parents, guardians, teachers, physicians, nurses — are aware that 
the world as it affects children changes rapidly. An institution which 
would serve the world of children, as The Children's Hospital Medical 
Center does, has no choice but to change with it, or else fail in its mission. 

Some of the dimensions of change are well-known. For example, the 
infant death rate — the number of babies who are born alive but die 
within the first year — has dropped more than 70 per cent since 1915. 
Beyond the first year, the risk of death likewise has greatly declined. The 
chance of a person surviving all the hazards of infancy, childhood, and 
adulthood and of reaching at least the age of 60 has increased from less 
than 50 per cent in 1900 to more than 75 per cent today. Even for those 
beyond 60, the outlook is much improved. The average expectancy at 
60 is for 17.5 more years of life; at 75, for 8.7 more years. 

The opportunity for longer, healthier, and more comfortable lives 
provided by the medical, agricultural, and industrial sciences has pro- 
duced profound effects. We are aware of the "vitamin kids," the boys and 
girls who grow taller and larger than their parents. We have heard much 
of the aging of the population and more recently, partly in reflection of 
the somewhat higher birth rate of the last twenty years, of its "younging." 
The proportions both of children and of older persons to that part of 
the population in the productive, middle years have increased, implying 
that those of breadwinning and homemaking age — the parents of our 
patients — may be increasingly caught in an economic squeeze. 

The nation has become concerned with the population "explosion" 
as it is called — a direct result of medical science's multiplying talents 
for keeping children alive. Within the lifetime of some of the Trustees 
of The Children's Hospital, the population of the United States has 
tripled. The total number of children has increased, the number of chil- 
dren per family has increased, and the proportion of children to total 
population has increased. Thus, the need for our chief products — pedia- 
tricians, pediatric nurses, and pediatric knowledge — has increased com- 
mensurately. Indeed, more than one of every three Americans, or about 
70,000,000, is in the age range served by The Children's Hospital Medical 
Center — that is, 19 or under. 

One blessing of the increased life expectancy is well known to our 
doctors and social workers who are in day to day contact with children 
and their parents, but is of interest to the public, and particularly those 
who engage in the planning and operation of community services. This 
is the "vanishing orphan." Forty years ago, 1.9 per cent of the nation's 



10 



child population had no mother or father; the figure is now 0.1 per cent 
— a 94.7 per cent decrease. In 1920, 16.3 per cent of children under 18 
had lost either their mother or father through death; in 1958, the per- 
centage was only 4.5. Thus it is that The Children's Hospital and the 
family of affiliated institutions making up its Medical Center must sup- 
ply the staff and basic facilities for treating more and more children who 
come to us from an intact home and need spend only a brief time with 
us. 

Another aspect of longer life is the emergence of new medical prob- 
lems as older ones are solved. In 1900, the principal killers of children 
were pneumonia, tuberculosis, and gastrointestinal infections. These in- 
fections still persist, in reduced numbers, but no longer present a great 
threat to life, thanks to the antibiotics and other health-restoring mea- 
sures. The child with pneumonia is commonly treated at home and re- 
covers quickly. Likewise, some of the principal child cripplers of former 
times — tuberculosis of the bone and osteomyelitis, for example — have 
diminished in importance as the result of effective, early treatment. In 
1960, the Hospital had one of it lightest years in the treatment of new 
cases of paralytic polio. This is not only a dramatic example of change 
but of the role of The Children's Hospital Medical Center in bringing 
change about, for it was here that the basic discovery of a method of 
cultivating polio virus was made; this break-through opened the way for 
the Salk vaccine. The wider use of the present or of improved vaccines 
will surely bring about the control of this dread disease and so eradicate a 
leading cause of orthopedic handicaps. 

Today, different pediatric problems have come to the fore. Acci- 
dents, cancer, and congenital malformations are now the leading killers 
of children. Each of these disasters of children, particularly accidents 
and birth defects, are major cripplers as well as killers. As children are 
saved from infections and as the population grows, the number coming 
to the Hospital with some form of cancer or with a congenital disease 
increases. 

In 1960, at a meeting of the American Public Health Association, 
Dr. Sidney Farber, Pathologist-in-Chief, reviewed developments in the 
chemotherapy and care of the cancer patient. Since he first introduced 
the antimetabolite drug, aminopterin, in the treatment of acute leukemia 
in children at this hospital in 1947, it has been possible to produce tem- 
porary (but as yet not permanent) recoveries. A few children have been 
kept alive from three to eight years after onset of their illness. Exciting 
progress also has been made here in the treatment of a cancer of the kidney 
with the antibiotic, Actinomycin D, in combination with small amounts 
of radiation. Children so treated are apparently normal and free of evi- 
dence of the tumor three years later, even though treatment was not un- 
dertaken until the disease had spread to their lungs. 

Childhood cancer remains one of the most important frontiers in 




"... different pediatric problems have 
come to the fore ..." 








"... a medical center which was 
predominantly an in-patient hos- 
pital is becoming a complex of spe- 
cialized outpatient clinics ..." 



11 



medical research; the program being carried out at The Children's 
Hospital Medical Center by an affiliated institution, the Children's Cancer 
Research Foundation, is commensurate to the size of the problem. We are 
the world center in the care and study of childhood cancer. 

Studies have shown that 5 per cent of all infants born alive have 
major congenital malformations of some sort, the most common being 
defects of the heart or major blood vessels, urinary tract, and intestines. 
Many of these defects are completely correctable through techniques of 
surgery in which Dr. Robert E. Gross, Surgeon-in-Chief, has pioneered 
at The Children's Hospital; in still other cases, disability can be greatly 
reduced. As Dr. Gross notes in his annual report, 1,818 operations for 
corrections of malformations were performed in the Department of Sur- 
gery alone during 1960. A large number of these operations, particularly 
those involving the open heart, could not have been attempted a decade 
ago. Now the child may undergo heart surgery and be back home in two 
weeks. Still other congenital defects present problems for solution by the 
orthopedic surgeon, the neurosurgeon, the neurologist, or others. 

Anyone familiar with the long and varied record of original scientific 
contributions emanating from The Children's Hospital and its affiliated 
institutions will recognize that we have hastened change. This change 
affects the Hospital itself as much as it affects children. One further ex- 
ample will suffice for the moment: The Children's Hospital began ninety- 
one years ago principally as a service to physically crippled children who 
occupied beds, often for long periods of time. Orthopedics, the specialized 
treatment of bone and joint diseases, was first developed here as a recog- 
nized specialty and, throughout its history, the Hospital has been a world 
leader in this field. Thanks to improvements in methods and systems of 
treatment and rehabilitation, however, a large number of orthopedic 
patients require relatively short periods of hospitalization and then can 
be treated in our orthopedic out-patient clinic and sent home after each 
visit. Still others require no hospitalization at all. In this way, our doctors 
can care for more patients and at a lower cost to parents. 

The same situation applies in other departments. For instance, Dr. 
George E. Gardner, Psychiatrist-in-Chief, in his annual report, provides 
us with a comprehensive description of the development of psychiatric 
out-patient services at the Hospital matching in-patient services available 
at the Judge Baker Guidance Center. Other clinics are too numerous to 
mention in this brief discussion but include fields of easily recognized im- 
portance — cerebral palsy, cystic fibrosis, epilepsy, speech and hearing de- 
fects, allergies, to cite a few. As a consequence of these developments, 
we have witnessed the phenomenon in the last ten years of a medical 
center which was primarily an in-patient hospital, convalescent home, 
and, in some instances, school for chronically ill children, becoming pre- 
dominantly a complex of specialized clinics — forty-one all told. Tabula- 
tion of 20,513 individual patients coming to the Hospital during the 



12 



fiscal year* ending September 30, 1960, showed that 10,871, or 53 per 
cent, were clinic patients and 9,642, or 47 per cent, were bed patients. 

Plainly, as we shall further elaborate, the advances that the Hospital, 
its staff, and its affiliates have scored through scientific research, through 
the training of child specialists, and through direct services to children 
have only served to broaden and deepen our responsibilities in a changing 
world. One is apt to think of an old hospital as having a Gibraltar-like 
fixity — as an established, material, and persistent element in the life of its 
community. Actually, The Children's has this kind of stability only in 
the continuity of its mission of service to children. Otherwise, it is the em- 
bodiment of the changing needs of children. It must remain so, and indeed 
must move more rapidly in meeting change than it has heretofore, if it 
is to continue to fulfill its mission. In summation, we feel that the words 
used by Dr. George P. Berry, Dean of the Harvard Medical School, exactly 
fit our own situation: ". . . No institution can afford to live off the capi- 
tal of tradition. None know better than those who labor here that history 
is a bank account which must be constantly renewed. . . ." 

Dimensions of Service 

The Children's Hospital Medical Center serves the world of children 
in many directions and a variety of dimensions. 

The most obvious dimension is the direct care of children. Whereas 
we are sometimes known as The Children's Hospital of Boston, the ac- 
companying chart showing the sources of our patients demonstrates the 
extent to which we are a community, state, national, and world institu- 
tion. We serve children everywhere, and many more from outside Boston 
than from within it. Last year, 13,701 of our 20,514 hospital and clinic 
patients came from outside of Boston, 11,381 from elsewhere in Massa- 
chusetts, 2,190 from elsewhere in the United States (many from neigh- 
boring New England states), and 130 from elsewhere in the world. For 
the most part, those coming from abroad present complicated problems 
of diagnosis and treatment, either due to the rarity of their disease, the 
obscurity of signs and symptoms, or the lack of generally effective knowl- 
edge of how to proceed. By no means all these children have a hopeful 
outlook, but, as Dr. Charles A. Janeway, Physician-in-Chief, observes in 
his annual report, our Hospital becomes the court of last resort. The 
general assumption is that our pediatric scientists, working at the growing 
edge of knowledge, may find a solution where others cannot. At the same 
time, we render some types of service that are largely local or regional in 
nature; our emergency clinic continued to grow last year, as it has for the 
last decade, as a first line of defense against accident injuries and other 
acute conditions. 




world 




"... our pediatric scientists may find a 
solution ..." 



*CHMC recognizes two different years — an academic year ending June 30, a hos- 
pital accounting year ending September 30. 



SOURCE OF CHILDREN'S HOSPITAL PATIENTS BY PLACE OF RESIDENCE 

For the Year Ending September 30, 1960 



MASSACHUSETTS 



18,194 




Boston 



ELSEWHERE IN MASSACHUSETTS: 

Barnstable County 129 

Berkshire County 101 

Bristol County 597 

Dukes County 4 

Essex County 1,290 

Franklin County 59 

Hampden County 643 




Hampshire County 
Middlesex County 
Nantucket County 
Norfolk County 
Plymouth County 
Suffolk County 
Worcester County 



6,813 



11,381 

65 

4,581 

24 

2,045 

651 

634 

558 



ELSEWHERE IN THE UNITED STATES: 



2,190 





Alabama 


9 


Missouri 


3 






Alaska 


2 


Montana 


4 




'^ r^) 


Arizona 


3 


Nebraska 


4 




->, . 


Arkansas 


3 


New Hampshire 


431 






California 


16 


New Jersey 


52 






Colorado 


1 


New York 


214 






Connecticut 


367 


North Carolina 


8 






District of Columbia 


9 


Ohio 


15 






Florida 


51 


Oklahoma 


1 






Georgia 


11 


Pennsylvania 


19 






Idaho 


1 


Puerto Rico 


1 






Illinois 


9 


Rhode Island 


412 






Indiana 


3 


South Carolina 


9 






Iowa 


8 


Tennessee 


3 






Kansas 


2 


Texas 


6 






Kentucky 


6 


Vermont 


83 






Louisiana 


2 


Virginia 


15 






Maine 


359 


Washington 


2 






Maryland 


13 


West Virginia 


4 






Michigan 


15 


Wisconsin 


5 






Minnesota 


8 


Wyoming 


1 




ELSEWHERE 


IN the world: 








130 




Africa 


2 


Europe 


25 




Asia 


3 


Mexico 


15 




, / J 


Canada 


40 


South America 


31 






Central America 


7 


West Indies 
grand total 


7 


20,514 



14 



A second dimension of service, also obvious, is that of a training 
center, as part of Harvard Medical School. Dr. Edward B. D. Neuhauser, 
Radiologist-in-Chief, points out in his annual report that, when the So- 
ciety of Pediatric Radiology was formed last year, two thirds of the 
charter members were found to have obtained their resident training in 
pediatric radiology at The Children's Hospital. The program of Dr. 
William T. Green, Orthopedic Surgeon-in-Chief , for the resident training 
of orthopedic surgeons is one of the most, if not the most, sought-after 
in the country; many of the professors of orthopedics in other medical 
centers have been trained here. Dr. Gardner heads one of the world's 
largest centers for the training of child psychiatrists, a specialty in which 
the nation is in extremely short supply. The Department of Medicine, 
under Dr. Janeway, conducts the largest teaching program in the C. H. 
M. C. and, as it pertains to pediatricians, one of the largest in the world. 
These examples could be extended to include other specialties and other 
professions than medicine. At all times, we have, in addition to the regular 
professional staff, more than 200 doctors and nearly 200 student nurses 
in training in The Children's Hospital. A substantial proportion of the 
doctors come from abroad. 

Our educational responsibilities recently have extended into hospital 
administration. In June, Mr. Aslam Gundas, administrator of the Chil- 
dren's Hospital in Ankara, Turkey, came here under the sponsorship of 
the Rockefeller Foundation for a one-year tour as administrative resident, 
following a year at the University of Chicago Clinics. 

A third and likewise obvious dimension of service is scientific re- 
search. It is not possible to detail here the long list of scientific "firsts" that 
have occurred in The Children's Hospital Medical Center. They range 
from the several Gross heart and blood vessel operations and the several 
brain operations developed by Dr. Franc D. Ingraham, Neurosurgeon-in- 
Chief, to basic knowledge of blood and neurological diseases and bone 
growth worked out by others, among them Dr. Louis K. Diamond, the 
late Dr. Bronson Crothers, and Dr. Green. The "iron lung" was developed 
here; so was the life-saving blood replacement tranfusion for "Rh babies." 
Our firsts include the Nobel Prize-winning work of Dr. John Enders' 
Laboratory; Enders and his associates not only were first to cultivate polio 
virus in non-nervous tissue, making a polio vaccine possible, but more re- 
cently have attenuated the measles virus and developed a measles vaccine 
now undergoing clinical trials. 

The Children's Hospital Medical Center research and educational 
programs receive $1,700,000 a year in outside grants, exclusive of the 
programs operated independently by the Children's Cancer Research 
Foundation and the Judge Baker Guidance Center. Inclusion of the 
latters' research programs would bring the total to more than $3,000,000. 

Other dimensions of service are not so well recognized or so well 
financed but are no less valuable to humanity. There are, for example, 



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. . A training center ..." 



"... A long list of firsts in scien- 
tific research ..." 




heart and blood vessel 



operations . 




"... the basic knowledge of 
bone growth ..." 




"... the lifesaving blood re- 
placement for Rh babies ..." 



15 




"... An institution whose mem- 
bers are deeply involved both as 
experts and good citizens in the 
life of this country ..." 



what we haven chosen from the administrative viewpoint, to call the un- 
seen, or silent, services; they are, at any rate, wholly voluntary and largely 
unsupported from outside sources. Perhaps the best example is the free 
consultations that our staff of 250 physicians give, as a matter of custom 
and a function of leadership. Daily, every department receives requests by 
letter or telephone from doctors all over the world for an expert opinion 
on diagnosis or treatment of difficult cases. 

One might visualize the busy professor of pediatrics as constantly 
moving from one child to another in a crowded clinic, or making ward 
rounds in the hospital, but the many visitors to the office of Dr. Janeway 
are struck by the fact that one of his chief functions is as an answering 
service. There are the many interruptions as he takes long-distance calls 
— perhaps to help a parent find a good pediatrician in Madras, Cairo, or 
Dallas. In his annual report, he points out how many members of his 
staff make contributions in the public interest as trustees, chairmen, or 
committee members of various charitable organizations of local or na- 
tional scope. "This is no ivory tower," Dr. Janeway remarks, "but an in- 
stitution whose members are deeply involved both as experts and good 
citizens in the life of this country." 

Dr. Gross devotes several weeks a year to evaluating candidates 
for certification as specialists and for surgical society membership. 
He gives free consultation by mail, spending from twenty to thirty hours 
a month on from sixty to eighty case histories referred to him from 
various parts of the world. Dr. Farber's department receives some ten 
telephone calls a day for free consultation on questions of pathology. Dr. 
Neuhauser, who gave twenty-two lectures on radiology at meetings out- 
side of Boston in 1960, receives X-ray films by mail with requests for his 
expert opinion; he estimates that he gives about 100 such free consulta- 
tions a year. Dr. Gardner estimates that he spends 30 per cent of his time 
answering questions by letter, telephone, or personal interview. These 
mainly involve helping parents find psychiatric treatment for their chil- 
dren in this country or abroad and advising students where to seek psy^ 
chiatric training. Much of this free consultative work is carried on even- 
ings, holidays, and weekends, in addition to his responsibilities as a clini- 
cian, teachers, researcher, editor, and administrator. Dr. Green, who shares 
with other Chiefs the energy and motivation to work almost continuously, 
is in great demand as an educator in orthopedics; last year, despite three 
weeks as a hospital patient himself, he was lecturer or moderator at 
twenty-eight meetings in nine states, not counting five lectures during a 
two-week trip to Brazil. Our doctors travel throughout the world, to give 
courses in Scotland, to make investigations in Africa, to survey Russian 
progress in infant care, to speak at an international meeting in Japan, and 
so on. They are in addition editors of a large number of professional 
journals. 

Several of the staff serve as advisers or consultants to various agencies 



16 



of the Federal Government, among them Dr. Ingraham, Dr. Gardner, 
and Dr. Janeway, as well as others. For example, Dr. Farber is a member 
of the National Advisory Health Council, and served on the Jones 
Committee, which made recommendations for a Federal medical re- 
search program emphasizing long-term support of medical scientists 
and research centers throughout the country. This program has been 
to a great extent enacted. But we are tempted to digress here to 
point out that, while scientific discoveries are a major source of the 
fame of The Children's Hospital and therefore research support is 
of prime importance, the increased availability of monies for research 
enlarges, rather than reduces, the Hospital's need for capital funds, 
which will be mentioned later. In addition, the Hospital is represented 
in the leadership of most, if not all, of the major national voluntary 
health organizations — for example, by Dr. Gross, in heart; Dr. William 
Berenberg, in cerebral palsy; and Dr. Harry Shwachman, in cystic 
fibrosis. 

We have provided no more than fragmentary sampling of the unseen 
services, or outside activities, of our staff. Yet the examples given should 
be enough to illustrate what demands the public, medicine, and science 
make upon the Hospital because of its reputation as a national and inter- 
national resource in child health. We can applaud the civic participation 
and professional leadership of our staff, take great pride in their capacity 
to accelerate progress in science and education, and take full cognizance 
of the spiritual satisfactions to be derived from such contributions; yet 
we remain aware that outside demands on staff time are a tax on the 
primary service function of the Hospital. In this special sense, we are not 
a tax-exempt corporation, any more than we are a self-sufficient enter- 
prise that can live and flourish solely through its own efforts. Indeed, for 
our economic survival, we are dependent on legacies and large gifts repre- 
senting both the last testaments and living testimonials of the Hospital's 
many good friends — expressions of their faith in the soundness of its mis- 
sion and the certainty that its service in the future will equal or surpass 
that in the past. 

The responsibilities which leadership in the pediatric sciences impose 
on our senior staff, not only in their personal contributions and services to 
children and in their own activities as teachers and scientific investigators, 
but equally so in their service on advisory boards and committees of gov- 
ernmental and voluntary agencies, have increased to the highest point 
in the history of the Hospital. This increase, bringing even the most 
gifted and energetic man to the threshold of fatigue, beyond which he 
cannot function efficiently, emphasizes the need for strengthening our 
medical staff in many quarters. The solution, the many discussions of the 
Staff's Planning Committee have indicated, appears to lie in more 
adequate staffing and financial support in depth — double-staffing of 
senior men in full-time positions — plus increased space to accommodate 




"... much of this free consultative 
work is carried on evenings, holidays 
and weekends ..." 




"... almost continuously in de- 
mand as an educator in orthope- 
dics ..." 



17 




A bold new program emphasizing 



additional staff and some changes in concepts of hospital and depart- 
mental management to achieve more effective delegation of authority. 
But such a solution would require a greater availability of assured income 
for creating and maintaining permanent staff positions — positions in- 
finitely preferable from both the scholar-physician's and hospital's view- 
point. We are reminded of the axiom in business management that the 
first task of a new president of a corporation is to choose his successor. 
This would be easy enough to do at The Children's Hospital, some of our 
Chiefs of Staff have remarked, /'/ ive had the money. In contrast, many 
of our senior men have been obliged to raise themselves and their depart- 
ments by their professional bootstraps, depending on private practice not 
only to support themselves but some part of their teaching and research 
programs. 

At present, we have not a single professorship that is adequately 



long-term support of medical scientists and endowed; the chairs held by Drs. Janeway and Gross are supported only 
research centers ... on a partial basis and therefor require considerable strengthening. In 

addition to these, we could use ten fully endowed faculty positions, 
including both full and associate professorships with the doctor's basic 
income provided at no cost to the Hospital. The medical staff presently 
receives some funds from the Medical School, but our teaching program 
is not as strongly supported as it should be in any department. 

The creation of endowed professorships provides a method by which 
teaching can pay its own way, and enable the donor to invest in a posi- 
tion that will perpetually strengthen the Hospital in its services to 
patients. In 1960, we were fortunate in being able to take one step 
toward augmenting our senior staff. We received from a donor who 
wishes to remain anonymous securities valued at $450,000. After careful 
consideration by the Planning Committee of the Staff in consultation 
with the donor and the Trustees, the decision was to ask the Medical 
Faculty of Harvard to establish a chair in child neurology at The Chil- 
dren's Hospital as a focus for a new program of neurological research, 
constituting an attack on some of the major causes of crippling and 
death in children, including hereditary afflictions and the accidental 
defects of gestation and birth. This will constitute a contribution to the 
Harvard Medical Center's program to strengthen the medical faculty. 
In this connection, it is of interest to note the scheme devised by 
the School's Office of Development to enable smaller foundations and 
voluntary agencies to create professorships, that is to make a tangible 
investment in people on a pay-as-you-go basis. The proposal is simply 
that the donor commit himself to give the Harvard Medical Center 
$60,000 a year for ten years; of this amount $2 5,000 is used currently 
during this period to pay the professor's salary, and Harvard University 
invests the remaining $3 5,000 at 5 per cent; at the end of ten years, the 
professorship becomes fully endowed and meanwhile the incumbent has 
pursued an active career of research, teaching, and service. In a manner 



18 



of speaking, this is a way of having one's philanthropic cake and eating 
it, too. An additional attraction from the giver's standpoint is that the 
scholar-physician holding a $25,000-a-year professorship can attract 
Federal and voluntary research grants in the range of $250,000 to 
$500,000. In this way, the original endowment becomes a prime mover 
in a full-scale program in a given field. 

Planning for the Unpredictable 

Our Medical Center is a general hospital for children. The business 
of a general hospital that serves its community is threefold: It is to meet 
human crises as they occur, to provide continuous care of the sick as 
they need it, and to engage in a broad program of disease prevention 
and health promotion. That it will need to do these things and do them 
well is wholly predictable. We must be prepared to meet all emergencies 
as they occur, and yet we do not know what the emergency will be until 
it arrives. We must be prepared to apply the latest scientific advances 
in disease prevention or treatment, but we do not know what they will 
be until they are discovered. 

We find a ready example in poliomyelitis. The Massachusetts polio 
epidemic of 195 5, which threw a great burden on our facilities as a state 
and regional center for the treatment of infantile paralysis, was un- 
predictable. The laboratory break-through that made the polio vaccine 
and the ultimate control of the disease possible also was unpredictable 
in time of discovery. An epidemic may fill a hospital's wards: a vaccine 
or the mere absence of epidemics may in time empty them. 

The same situation may be observed in heart surgery. It has been 
estimated that a quarter million children have congenital heart defects 
cheating them of a robust childhood or of life itself. Only a few of these 
defects could be repaired prior to open-heart surgery. Dr. Gross has 
pointed out that the development of open-heart surgery did not be- 
gin until a surgeon at the University of Minnesota chanced to read in 
a British medical journal of some successful experiments in the cross- 
circulation of blood in dogs, a sort of continuous transfusion in which 
the heart of one would do the work for two. The first open-heart sur- 
gery in humans was done in this way, with a parent's circulation being 
linked to his child's. Heart surgeons realized what could be accomplished 
by using standby heart and lungs while the patient's heart was stopped. 
Efforts to perfect a heart-lung machine, pioneered at Jefferson Medical 
College, were redoubled, here and elsewhere, with rapid success. Today, 
surgery on the open heart, while complex and requiring great skill and 
teamwork, is a commonplace at this Hospital. Operations can be carried 
out on 75 per cent of all malformations of the heart and major blood 
vessels observed in children over one year of age. In his annual report, 
Dr. Gross points out the effect on the surgical caseload in this Hospital. 
We witness quickly rising curves in the numbers of new types of opera- 
tions, followed by drop-offs. What happens, he observes, is that when 




"... An epidemic may fill a hospi- 
tal's wards; a vaccine may in time 
empty them ..." 




"... We must be prepared to apply 
the latest scientific advances but we 
don't know what they will be until 
they are discovered ..." 



19 




"... when 
is developed at 



a new surgical technique 
Children's Hospital ..." 



a surgical technique is originated or developed at The Children's Hos- 
pital it attracts patients for a time but, when the technique is adopted 
by surgeons in general hospitals elsewhere, our patient load in this di- 
rection drops off. 

This is how medical science progresses. The cost of progress, in 
economic terms, can be read not only in the rise and fall of patient 
revenues from different services but the Director's seeming obsession 
with an unpleasant topic: money. In 1960, the Hospital admitted 9,924 
patients for bed care, about the same as 1959 (9,919) but these patients 
stayed a little longer on the average, 9.3 versus 9.2 days (including 
convalescent patients). With a bed capacity of 3 54, the average daily 
in-patient census was 254 (71.8 per cent) against 250 (70.7 per cent) 
the year before. It is impossible to operate any hospital at 100 per cent 
of capacity, but a 10 per cent increase — to 80 per cent or so — would 
have completely wiped out our 1960 operating deficit of $275,250 and 
left a substantial sum for other purposes, such as the payment of house 
officers' salaries or the improvement and expansion of clinic and research 
facilities. 

Miss Muriel B. Vesey, in her annual report as Director of the Nurs- 
ing Service, deals with another element of unpredictability in hospital 
operation: personnel turnover. We have a regrettably high rate of 
turnover in our nursing staff. Many nurses are prone to leave in the early 
part of the summer. This is the time when our in-patient census rises 
to its highest peak, due to the fact that parents bring in their children 
for elective surgery at the close of the school term (we tend to reach an 
annual high in June and annnual lows in September and December). 
Asks Miss Vesey: "Does one attempt to staff for the peak or try to 
strike an average?" Neither approach is wholly satisfactory. While the 
turnover is most serious in nursing (children require more nursing than 
adults) , the problem is not confined to nursing. Mr. Alexander Brown, 
Personnel Director, points out in his annual report that 600 employees 
left C. H. M. C. in 1960; this is close to a 50 per cent rate of turnover. 
This phenomenon is not uncommon among hospitals — due in part to 
their low salary scale, insufficient staffing, and inequitable work loads 
— but it is costly, both in the dollars-and-cents expenses of hiring and 
training and in operating efficiency. Through study and revision of 
personnel policies, the Administration is endeavoring to improve the 
situation. Wage and salary increases in the last year totaled $175,000. 
We may expect a continued upward trend in payroll. 

A moment ago, we mentioned the house officer salary and working 
space problems. We did so deliberately, although not without misgivings 
for they both have become sensitive areas in this Hospital. 

The Children's Hospital Medical Center is, insofar as we know, 
the last teaching hospital in the country without a salary program for 
the support of interns and residents — the house staff. At one time it was 



20 



an occasion for pride to state that the opportunity for training at The 
Children's Hospital was so attractive to the medical graduates of the 
nation they would come without pay. Today, the climate of opinion 
regarding the sacrifice has changed. We fully agree that a teaching 
hospital should pay its house officers at least a modest stipend, over and 
above the traditional board, room, and laundry. Many are married; some 
have children; many have already incurred debts for their medical 
schooling. In addition, lesser hospitals offer fairly attractive sums in order 
to attract house officers. 

In 1960, impetus for payment of house officers arose with the 
Trustees' establishment of the John Wells Farley Memorial Fund, in 
honor of the late Chairman of the Children's Medical Center 
Board of Trustees. The proposal was to raise money for an endowment, 
the income of which would be used as the nucleus of a house officer 
salary program. To lead the way, Mike Farley's friends raised more than 
$100,000 in his memory. It was recognized that endowment for a total 
program would fall in the neighborhood of $5,000,000 and therefore it 
probably would be necessary to find the resources in ways other than 
endowment alone. 

As the year ended, a survey by the Office of Development showed 
that of 106 house officers logically entitled to compensation for their 
services to the Hospital, 61 received annual amounts varying from $1,000 
to $7000 and 45 received nothing. The breakdown by departments is 
instructive: 



PAID NOT PAID TOTAL 



PAID NOT PAID TOTAL 



Medicine 


9 


29 


38 


Radiology 


4 





4 


Surgery 


12 





12 


Orthopedics 


6 


10 


16 


Anesthesia 


9 





9 


Psychiatry 


11 





11 


Neurosurgery 


3 





3 


Dentistry 


2 





2 


Pathology 


5 


6 


11 


GRAND TOTALS 


61 


45 


106 



It is obvious that those least apt, or able, to pay their interns and 
residents are Medicine, Pathology, and Orthopedics. The survey found 
that the Hospital currently paid $43,392 a year in house officer salaries, 
whereas $118,514 was paid from other funds (of a temporary or 
special nature). Under the salary scale contemplated, it appears that 
a house officers' salary budget would total approximately $275,000 a 
year. 

Consideration of the solution by the Board of Trustees was pending 
as the year closed. 

The second topic of interest here is the problem of space — not outer 
but inner space, specifically floor space. There is a growing — indeed, 
now crying — need for expanded facilities for clinics and for research. 
These are two needs, really; they are equally pressing, and will become 




"... In I960, impetus for payment 
of house officers arose with the establish- 
ment of the John Wells Farley Memorial 
Fund ..." 



21 




"... better physical arrangements 
for our ambulatory services ..." 



more so within the next year or two. The Cardiology Division under Dr. 
Alexander Nadas, which supplies the diagnostic foundation for heart 
surgery, cannot expand, and indeed is blocked from obtaining a large 
Federal grant for operation of a cardiology research center by lack of 
space. The anticipated appointment of a professor of child neurology, 
as mentioned earlier, will compound the problem. He will need a lab- 
oratory and offices for himself and his staff. Large grants for neuro- 
chemical and neurophysiological research are obtainable from both pub- 
lic and voluntary sources, such as the National Institute of Neurological 
Diseases and Blindness and the National Foundation. They depend in 
this case on bricks and mortar. 

Many other examples of a space bind could be cited, but the most 
critical one administratively is in facilities for the diagnosis and treat- 
ment of out-patients. Our forty-one clinics are presently scattered, mak- 
ing for uneconomical operation from a bookkeeping and transaction 
standpoint; they are tucked around, wherever a room or two could be 
found. Our main Out-Patient Department in the old Hospital (Building 
A) is converted in-patient facilities. Many different departmental services 
have been crowded into this space; anyone who has visited our "OPD," 
as we term it, would agree that it was not in keeping from the standpoint 
of utility or comfort with our newer facilities, even though some small 
improvements have been undertaken. Among other things, we lack 
comfortable waiting rooms for the parents, usually mothers but some- 
times fathers and occasionally mothers and fathers who crowd the few 
benches and chairs with their children, often not only with the patient 
himself but other members of the family as well. It has been most diffi- 
cult to maintain a spirit of sympathetic understanding and good public 
relations under such circumstances. There have been complaints. Where 
a sick child is involved, parental emotions are involved. Some criticisms 
have been well founded. 

Dr. Janeway's annual report clearly depicts the source of our em- 
barrassment. The Medical Department has witnessed a 72 per cent 
growth in its out-patient load in the last fourteen years, in contrast to 
a 32 per cent decrease in acute in-patient admissions and a 42 per cent 
decrease in days in the hospital. The decreases in admissions of and 
hospital stay of chronically ill children have been even greater. Yet the 
most recent construction, itself sorely needed at the time it was completed 
in 1954, was primarily for in-patient facilities. 

It was chiefly to provide funds for a new clinic and research build- 
ing, linking the present old and new Hospital buildings, that our present 
limited annual fund-raising campaign — the December Appeal — was be- 
gun six years ago. Some $2.3 million now has been raised, exclusive of 
a promise of $700,000 from the Federal government. Approximately 
$500,000 was added in 1960. Original plans for the building have be- 
come obsolete, however, and the first estimate of the cost of this small 



22 



building — $4,000,000 — is subject to upward revision. 

Beginning of construction has been delayed in the face of the fact 
that, as Mr. Wolbach pointed out, a new building would increase Hos- 
pital operating costs at a time when the annual deficit threatened to 
reach $1 million. This is a dubious distinction that the Director hopes 
never to achieve. Decision to go ahead on the Clinic and Research build- 
ing more recently has been delayed pending clarification of (1) the 
objectives of the Harvard Medical Center and its $58,000,000 Program 
for Harvard Medicine and (2) discussions of a new combined hospital 
building, or hospital complex, furnishing combined facilities for several 
of the teaching hospitals adjacent to the Medical School. Whereas The 
Children's Hospital Medical Center fully believes in and is committed 
to pursue its own destiny, as a separate institution, it for many years 
has worked cooperatively with other Harvard teaching hospitals and 
would be willing to extend areas of joint activity where integration of 
efforts would improve service to patients and effect economies or im- 
prove efficiency. 

As a result of information furnished to the Trustees and Chiefs of 
Staff by Dean Berry and members of his staff, it is now clear that the 
area in which the Hospital and School can most effectively cooperate is 
in the raising of funds (1) for the endowment of professors working 
in the Hospital and (2) for strengthening departmental staffs associated 
with these professors. This effort in fact is the sole purpose of the Pro- 
gram for Harvard Medicine (beyond endowment of a new Medical 
Library, already accomplished). Dr. Berry has made it clear that brick- 
and-mortar problems rest with the hospitals, and that they should pro- 
ceed in construction and its financing in any way they see fit. 

It is now possible to perceive the advent of a combined hospital 
building as a long-range goal of the Peter Bent Brigham and other 
interested hospitals, something which will consume some years in its 
realization; hence it is easy to recognize that this objective offers no 
solution for our own space problem. The need for a Clinic and Research 
Building is so short in range it would seem to be point blank. We need 
such a construction, costing perhaps as much as $6 to $7 million, im- 
mediately. It remains to be determined what it will contain and how it 
will be fully financed. But these decisions should be reached in 1961. 
This brief discussion of the many variables that affect sound planning 
and development for the future documents our earlier point that the 
needs of children change and therefore the needs of a children's hospital 
change. This much is predictable. But that, we may sum up, is about all 
that is predictable. Exactly what changes will occur and what the future 
will hold is a question that continually perplexes the governing officers, 
the administrative staff, and the medical staff of the Hospital. One other 
thing is wholly predictable, by the way — the cost of operations will 
continue to rise. 



"... brick and mortar 
with the hospitals ..." 



problems rest 








J 



"... the greatest source of 
higher costs is our investment in 
highly skilled personnel ..." 



23 



Costs: Every Hospital's Headache 

During 1960, the administration completed its installation of a new- 
accounting system aimed at accurate determination of the cost of pa- 
tient care, of teaching, and of research. On the basis of this system, known 
as responsibility accounting, we began developing departmental budgets 
that, when in full operation, will enable the Hospital to present the 
Trustees with a complete analysis of accurately identified costs of opera- 
tion, making it possible to eliminate unnecessary expenses and properly 
allocate financial responsibility for necessary expenses. 

The American Hospital Association has estimated that the costs of 
operating hospitals have risen 50 per cent in the last ten years, and will 
rise as much again in the next ten. We estimate that our costs rose 60 
per cent in the last decade, and will go up 60 to 70 per cent in the next 
ten years. The greatest source of higher costs is salaries, which make up 
70 per cent of the ordinary hospital's budget; in the first-class care of 
children, the pediatric hospital often finds its personnel costs exceeding 
that percentage, since the ratio of employees per patient must be higher; 
in fact, with a payroll of 1,400 employees, the Children's Hospital ratio 
of employees to patients is more than twice as high as the average general 
hospital. Where the national average hospital cost per patient per day 
was $31 (1959), our cost in 1960 was $45; board and room amounted 
to $30 and diagnostic and therapeutic service charges to $15 a day. 

As the Treasurer's Report shows, The Children's Hospital Medical 
Center was able to increase its gross patient revenue $306,000 in 1960 
despite a $175,000 jump in operating costs (wage and salary increases), 
largely by increasing in-patient rates from $26 to $27 a day and out- 
patient fees from $3 to $4 per visit and meanwhile rendering a slightly 
greater amount of patient services than the year before. 

Since the total annual deficit charged against the general fund was 
reduced approximately $300,000 by this experience (plus a somewhat 
larger return on investments and increased allotments from affiliated 
institutions) , one might well ask why not raise the rates to a point where 
we could make ends meet. We may feel forced to recommend another 
small increase in the coming year in order to improve our operating 
position and to reduce the destruction of capital — the invaluable "hard 
money" that all medical institutions these days find so hard to come by. 

As the result of improved administrative statistics, however, we can 
provide one good reason why we should try to avoid further rate increases 
as long as possible and preferably find increased resources elsewhere. 

In 195 8, the Department of Commerce informs us, the average 
American family had an income of $6220. Analysis of data obtained in 
admission interviews by the Comptroller's Office revealed that 68 per 
cent of the families of our in-patients and 75 per cent of the families of 
our out-patients earned less than this national average. Where only one 
out of three American families fall in the $2000-$6000 salary class, two 



24 



out of three of the families of Children's Hospital patients fall in this 
class. The ratio is three out of four in the case of out-patients' families. 
The median range of family income for in-patients is $4940-$ 5200 and, 
for out-patients, $4420-$4680. 

Fifty per cent of our in-patients are covered by some form of Blue 
Cross prepaid hospitalization, the most popular plan being one that pays 
$15 a day against our $27 charge for board and room and pays $15.97 a 
day for ancillary services, leaving the parents with $12 a day to be paid 
out of pocket, or the Hospital in the position of subsidizing about $14 
of the $45-a-day cost of operation. 

Beyond the 50 per cent who have Blue Cross, 20 per cent have other 
forms of hospital insurance, 18 per cent are welfare cases paid at agreed 
rates much less than cost, and 12 per cent receive free care. 

Blue Cross or Blue Shield provide only a minimum of coverage for 
out-patients, the benefits usually applying only in emergency cases or 
the treatment of fractures. 

From these remarks, it may seem that The Children's Hospital 
Medical Center, despite what appear to many to be high rates, serves a 
preponderantly lower middle-class economic group at revenue-producing 
levels considerable below cost. Indeed, with an operating revenue of 
$6,3 5 5,699 in 1960, the level was $1,306,843 below cost. As offsets, we 
received a total of $31,257 from the United Community Services and 
$14,000 from the Committee on the Permanent Charity Fund. Con- 
sidering that we are a private hospital receiving no public tax support, 
it may be concluded that the Hospital is rendering a truly charitable, 
philanthropic, and humanitarian service to its community. 

That we are able to do so, by providing an immediate service to more 
than 20,000 children and immeasurable services to the children of the na- 
tion and the world who benefit from knowledge developed or imparted 
in our institution, is a tribute to the generosity of our Trustees and our 
friends, more than 14,000 of whom made gifts to the Hospital in 1960. 
It is simultaneously a tribute, it goes almost without saying, to our 
doctors, nurses, social workers, technicians, volunteers, and many other 
employees who have upheld the tradition that we take care of children, 
as they come, and only secondarily concern ourselves with the cost of this 
care. It is the responsibility of the Director to accept this secondary 
concern, but he would be a foolish hospital administrator indeed if he 
did not make it explicitly clear that he feels that he pursues sound 
practices of leadership and management in order to assure the continuity 
of the primary mission. Putting it another way, he too recognizes that 
a children's hospital measures its profits not in dollars but in children 
served. 

Joseph P. Greer, Director 




25 




"... a children's hospital measures its profits not in 
dollars but in children served ..." 




26 





"... The plan that created The 
Children's Medical Center called 
for the gathering together, within 
one organization, of all aspects of 
Medicine, Surgery and the Labora- 
tory Sciences that concern them- 
selves with the normal and the sick 
infant, child and adolescent ..." 



IWM 




27 



PLANNING COMMITTEE'S REPORT 

The seven Chiefs of Staff of The Children's Hospital Medical Cen- 
ter make up the Planning Committee, which in one form or another 
reflects a continuity of planning and development going back to 1931. 
In that year, Drs. Kenneth Blackfan, William Ladd, Frank Ober, S. Burt 
Wolbach, and the present Chairman constituted the Committee. The 
present members are Drs. Robert E. Gross, Charles A. Janeway, William 
T. Green, George E. Gardner, Edward D. B. Neuhauser, Frank D. 
Ingraham, and the Chairman. The Director of the Hospital and the 
Director of Development are ex officio members. 

All but one of the above named physicians have been active on 
the Committee since the expansion of The Children's Hospital into The 
Children^ Medical Center in 1947. This title was amended by State 
legislation in 1959 to "The Children's Hospital Medical Center," a step 
on the part of the Trustees to achieve corporate identity of The Hospital 
and the Medical Center and thus move, insofar as feasible, toward closer 
integration of the family of institutions listed on the title page of this 
Annual Report. 

The plan that created The Children's Medical Center called for 
the gathering together, within one organization, of all aspects of Medi- 
cine, Surgery and the Laboratory Sciences that concern themselves with 
the normal and the sick infant, child, and adolescent. The pattern of 
centralization, encompassing a flexibility in the manner of merger or 
affiliation, has permitted institutions interested in children to join to- 
gether and, in so doing, not only create a great medical center but 
strengthen themselves. Some developments in this direction have ex- 
ceeded all expectations in the dimensions of the programs achieved — 
for example, the Judge Baker Guidance Center and The Children's 
Cancer Research Foundation. These two institutions and the Children's 
Mission to Children, which is concerned with social aspects of child 
care, are independent corporations affiliated with The Children's Hos- 
pital, the Infants' Hospital, and other units comprising the more unified 
administrative structure known as The Children's Hospital Medical 
Center. 

This C. H. M. C. structure contains the facilities for bed care and 
most of the ambulatory services, and it houses the departments of Radi- 
ology and Pathology, the Clinical Laboratories, and most of the research 
activities of the clinical departments. Harvard Medical School carries 
out the major part of its pediatric teaching function in The Children's 
Hospital or through the Hospital's affiliates. There are also close rela- 
tions — physical, spiritual, and intellectual — with the Peter Bent Brigham 
Hospital, which is connected with The Children's Hospital by a bridge 
over Shattuck Street. A similar bridge joins the Hospital with The 
Children's Cancer Research Foundation, which in turn connects through 



28 



a door with The House of the Good Samaritan. The Judge Baker 
Guidance Center is joined to the Hospital by a tunnel. 

Ten-Year Plan 

In 1959, the Planning Committee drew up a development program 
for a ten-year period to end in 1969, when the Hospital will celebrate 
its Centennial. Only the first three priorities of need will be discussed 
in this report. 

1. Out-Patient Services. The Planning Committee, in common 
with all students of medical care, recognizes that the Out-Patient De- 
partment (also known as the Ambulatory Services) represents one of 
the C. H. M. C.'s most important contributions to the care of children 
in this community, throughout the country, and over the world, the 
areas from which our patients come. A steadily changing pattern of 
medical care demands experience, skills, and services that are available 
only in institutions specially set up to deliver them; the pattern necessi- 
tates the provision of better physical arrangements for our Ambulatory "... new physical facilities for out- 
Services, together with increases in the numbers of experts in the several patient clinics ..." 

clinical divisions of child care, whose services are needed by other doctors 
in the care of their patients. Such ambulatory services do not substitute 
for home care by the practicing physician, but afford master consul- 
tation and specialized types of diagnosis and treatment that no one can 
rightfully expect in the office of the most competent private practi- 
tioner. 

The Planning Committee's recommendation of topmost priority 
therefore concerns the building of new physical facilities for out-patient 
clinics, so as to provide much better care to a larger number of infants, 
children, and adolescents and to extend the horizons of clinical research, 
medical education, and postgraduate training. 

2. Clinical Research Facilities. Fundamental research in the 
sciences basic to medicine, carried on mainly in the Jimmy Fund Building 
of The Children's Cancer Research Foundation, has created opportunities 
for the several clinical departments to apply new methods, and through 
application further expand their efforts, in their own programs of re- 
search in diagnosis, treatment, and prevention of children's diseases. 
The need for more adequate clinical research facilities, and indeed for 
working space of any kind, has become intense. Space is needed both for 
laboratories and research beds if programs of clinical investigations are 
to be carried on within the Hospital. Plans made more than five years 
ago, and since that time further elaborated, call for construction of a 
large building housing clinical research facilities and out-patient clinics, 
on a site between the present main hospital building (the Farley Building, 
formerly known as Building B) and the Longwood Avenue building 
(known as Building A) . 

These building plans were started long before the "explosion" of 




new laboratories for research 




29 



clinical investigation in the teaching and research hospitals of the nation. 
The initiation of clinical research centers, supported in part by National 
Institutes of Health grants of a size never before available, has brought 
our hope for a new building much nearer reality. 

A clinical research building is needed to bring the contributions 
of the basic medical sciences to the patient's bedside. The needs for such 
new or expanded facilities are evident in every department and division 
of The Children's Hospital Medical Center, including Psychiatry, 
Orthopedic Surgery, Cardiology and Cardiovascular Surgery, Pediatric 
Medicine, and Pediatric Surgery, and all their subdivisions including 
Neurosurgery, Neurology, Radiotherapy, Dental Medicine, Otolaryngol- 
ogy, and Ophthalmology, as well as other fields of activity now being 
developed at the Center. 

The second recommendation of the Planning Committee thus con- 
cerns the construction of such a clinical research center without delay. 

3. Development of Netv and Specialized Services. In 1960, the 

Planning Committee selected Child Neurology as the field of greatest 

importance for immediate development. Dr. Bronson Crothers, one of 

the great pioneers in this field, began his work (especially concerned with 

^^^^ cerebral palsy) more than forty years ago at The Children's Hospital, 

and the fine contributions of his successor, Dr. Randolph K. Byers, who 
will soon retire, have emphasized the value of a rapid expansion of re- 
search and patient care on this major front of Pediatrics. A bene- 
factor has provided Harvard Medical School with funds to support a 
new Chair in Child Neurology at The Children's Hospital Medical 
Center, thus opening the way for the Medical Faculty to seek a man 
to lead in the further development of neurological research here. A new 
program in Child Neurology cannot proceed at an optimal pace, how- 
ever, until facilities both for clinical and basic scientific investigations 
have been provided. 

The third recommendation of the Planning Committee is for a gen- 
eral strengthening in depth of the professional personnel of all depart- 
ments and divisions of the C. H. M. C. 

A long list of pressing needs in the development of both the clinical 
and laboratory approaches to the solution of pediatric problems has been 
prepared by the Planning Committee. These will be described in future 
reports as the plans are approved by the Trustees. 

The work load of the heads of departments and divisions has grown 
"... a strengthening in depth of the markedly since the end of World War II, but this growth has not been 
professional personnel . . . accompanied by an increase in the number of highly trained men in the 

supporting positions. The senior members of the staff have shouldered 
greatly increased responsibilities for the care of patients, for teaching, 
and for the conduct or supervision of expanding research programs in 
the last fifteen years. In addition, they have taken their place in the re- 




30 



sponsible governing bodies of voluntary health agencies, private foun- 
dations, and, above all, the Federal agencies concerned with medical and 
scientific research. 

Our original concept of The Children's Medical Center included the 
intellectual open door. We have welcomed, and continue to welcome, 
physicians and scientists from all over the world who are interested in the 
problems of early life, and we have participated, and continue to partici- 
pate, in the leadership for the creation and communication of new 
knowledge in pediatrics. 

The Planning Committee repeatedly has stressed with pride the na- 
tional and international adoption of programs in the various phases of 
medical research, patient care, and public health as they concern the 
child — plans representing multiplications and adaptations of efforts 
originally developed at the C. H. M. C. 

The objectives of a children's medical center, as discussed, can best be 
preserved and perpetuated by strengthening of the staff in terms of solid, 
permanent support for more persons in key positions. Such a strengthen- 
ing, of course, relates to — and, indeed, is interlocked with — the expan- 
sion of the facilities for ambulatory services and for clinical research de- 
scribed in the first two recommendations. 

The greatest limiting factors in overcoming the deficit in staff have 
been, in sum, the lack of space and of money. These factors have been 
responsible for loss of key men from our staff, further intensifying the 
personnel deficit. Some who left us, we are happy to say, continue to 
carry out the broad mission of the C. H. M. C, for they hold positions 
of leadership in hospitals and medical schools throughout the United 
States and in many other parts of the world. 

The Harvard Medical Center 

We cannot close this brief review without commenting on the role 
of The Children's Hospital Medical Center in the Harvard Medical 
Center, particularly taking note of two new programs in the Longwood 
Avenue area which, in their fulfillment, will enhance our future in pace 
with that of the Medical School, School of Public Health, and the other 
teaching hospitals associated with the School. 

The Children's Hospital is one of seven associated teaching hospitals 
participating with the Medical School in "A Program for Harvard Medi- 
cine," a development effort launched in 1960 and aimed primarily at 
strengthening the total Medical Faculty. The program calls for the rais- 
ing of $5 8,000,000, a portion of which is earmarked for support of the 
Hospital's teaching staff. The extent of the C. H. M. C.'s enthusiastic par- 
ticipation in the Harvard Medical Center's program may be judged from 
the fact that its President, Mr. Wolbach, is Treasurer of "A Program for 
Harvard Medicine." 

A second program of current interest is the proposed creation of a 



"... the Children's Hospital Medical Cen- 
ter in the Harvard Medical Center ..." 




31 




Harvard "Hospital Complex," an objective most easily visualized in 
terms of the creation of one of the "University Hospitals" associated with 
the School. The combined hospital proposed would include only a few of 
the several members of the Harvard family of teaching hospitals. The 
proposal is to construct a hospital complex on property owned by the 
Peter Bent Brigham Hospital — the ultimate solution for the space prob- 
lems of the Brigham. This plan offers a challenge and an opportunity to 
The Children's Hospital Medical Center to join in all activities, where pos- 
sible and where feasible, with those hospitals for adults which make up 
the complex. The potential gain lies in a combining of administrative 
and/or professional services wherever greater efficiency and economy 
may be achieved. The Children's Hospital Medical Center has approached 
the question of its participation and role in planning the hospital complex 
with deep and sympathetic interest. Its Chiefs of Orthopedic Surgery 
and of Neurosurgery also head those services in the Brigham, and there 
is a long tradition of close and happy cooperation between the two in- 
stitutions, and with other members of the proposed complex, such as the 
Boston Lying-in Hospital. 

Careful study is being given to the possibility of any means of 
combining services for the good of the patient. The Planning Com- 
mittee emphasizes, however, that when all such studies are finished, there 
still will remain an organization devoted primarily to infant, the child, 
and the adolescent — The Children's Hospital Medical Center. It is our 
belief that we will be most effective in carrying out our own mission by 
the pursuit of effective relationships with surrounding institutions. More 
explicitly, we believe that in the future, as in the past, our greatest con- 
tribution will be made if we continue as a separate group of institutions 
identified with child care, but working in the closest possible harmony 
and cooperation with the adjacent hospitals for adults, and always within 
the magnificent academic setting of the Harvard Medical School, School 
of Dental Medicine, and the School of Public Health. 

Sidney Farber, M.D., Chairman, Planning Committee 



"... There will remain an organization 
devoted primarily to infant, child and ado- 
lecent ..." 




JZ 



THE CHILDREN'S HOSPITAL MEDICAL CENTER 



BOARD OF TRUSTEES 



Adams, Charles F. 

Aldcn, Vernon R. 

Almy, Mrs. Robert B. 

Andrews, Kent 

Anthony, Julian D. 

Ayer, Neil R. 

Badger, Shcrwin C. 

Bartlett, Nelson S., Jr. 

Bartlett, Mrs. Nelson S. 

Batchelder, Mrs. Charles F., Jr. 

Berman, Matthew 

Bower, Albert B. 

Bronstein, Philip G. 

Brooks, John G. 

Buttrick, Stedman 

Cabot, Thomas D. 

Cooper, John L. 

Crocker, Frank W. 

Damon, Roger C. 

Dane, Walter A. 

Duane, J. Marshall 

Erickson, Joseph A. 

Estin, Hans H. 

Falvey, Donald 

Farley, Mrs. J. W. 

Flood, Richard R. 

Forbes, F. Murray 

Forbes, F. Murray, Jr. 

Francis, Mrs. Edward L. 

Friend, Mrs. Archer D. 

Friend, Mrs. Dale 

Fuess, Dr. Claude M. 

Fuller, Mrs. Robert G. 

Gardner, G. Peabody 

Gardner, George P., Jr. 

Gardner, Harrison 

Gardner, John L. 

Glcason, Francis H. 

Grccnbaum, Joseph 

Hallowell, Robert H. 

Hansel, Lawrence H. 

Harwood, Bartlett 

Hayes, Miss Helen 

Hellmuth, Paul F. 

1 lood, I [arvey P. 

Hopkins, Mrs. Robert H. 

Hovey, Mrs. Charles F. 

Howe, P. 1). 

Howland, Weston, Jr. 

Hunncwell, Arnold W. 

Isaacs, Kenneth I.. 

Jenney, Reginald 

Johnson, Edward C, 2nd 

Kahn, Milton 

John F, Kennedy, 

President of the United States 
Knight, Richard C. 
Ko/ol, Irank L. 



Kulp, Benjamin 
Laughlin, Henry A. 
Lewis, Arthur L. 
Livermore, Robert J. 
Lockwood, Arthur H. 
Lowe, John W. 
Manice, William D., Jr. 
Mason, Austin B. 
Mittell, David A. 
Mitton, Edward R. 
Moir, Mrs. John A. 
Morton, William F. 
Mumford, George S., Jr. 
Neal, Mrs. Kirke A. 
Nordblom, Robert C. 
O'Keeffe, Adrian 
Pappas, Thomas A. 
Peabody, Miss Amelia 
Perkins, Mrs. James H. 
Perry, Edgar A. 
Perry, Mrs. Roger A. 
Prouty, Mrs. Lewis I. 
Rabb, Norman S. 
Revere, Miss Margaret A. 
Ripley, Walter J., Jr. 
Rose, Edward 
Ross, Thorvald S. 
Rotch, Arthur G. 
Semenenko, Serge 
Sidd, Samuel 
Silverman, William A. 
Slosberg, Samuel L. 
Spencer, Mrs. Charles E., Jr. 
Stockemcr, George A. 
Swift, William N. 
Turner, Mrs. Howard M. 
Turner, James S. 
Warren, Howland S. 
Wheeler, Alexander 
Wheeler, Mrs. Alexander 
Wheeler, Mrs. Henry, Jr. 
White, Henry K. 
Whiteside, Alexander 
Wilder, Mrs. David 
Williams, Ben Ames 
Wing, Mrs. Raymond 
Wolbach, William W. 



CORPORATION MEMBERS 



33 



THE CHILDREN'S HOSPITAL MEDICAL CENTER 



Abbott, Gordon 
Anderson, L. Clayton 
Bain, Sherwood E. 
Beal, Mrs. William DeFord 
Berenson, Richard A. 
Bond, David S. 
Brewster, George W. W. 
Brigham, F. Gorham, Jr. 
Brin, Dr. Alexander 
Brooks, Francis H. 
Brooks, Mrs. Paul 
Brown, William L. 
Callahan, Raymond J. 
Catlin, Ephron, Jr. 
Clapp, Mrs. Eugene H., II 
Clapp, Joseph A., Jr. 
Coburn, Miss Louise 
Comerford, Richard, Hon. 
Coolidge, Mrs. T. Jefferson 
Crosby, W. Edgar, Jr. 
Darling, Nelson J. 
Devens, Charles 
Dik, Willard Blake 
Dorr, Richard G. 
Everts, Albert P., Jr. 
Febiger, Mrs. William S. 
Fitzgerald, Miss Adelaide 
Fitzgerald, James F. 
Flint, John G. 
Forbes, Mrs. F. Murray, Jr. 
Fulton, A. Oram, Jr. 
Gardner, Mrs. John L. 
Goodrich, John W. 
Gray, Roland, Jr. 
Hansel, Mrs. Lawrence H. 
Harding, Francis A. 
Hatch, Francis W., Jr. 
Hawkins, Mrs. Frederick D. 
Hollingsworth, Amor, Jr. 
Hopkins, Mrs. Edward B. 
Hovey, Chandler 
Hovey, Charles F. 
Howe, Henry S. 
Howe, Mrs. Parkman D. 
Hunnewell, James F. 
Jackson, Charles 
Jackson, James, Jr. 
Kiley, Mrs. John C, Jr. 
Kiley, John C. 
Kimball, Frederick M. 
King, John S. 
Kirk, John M. 
Klotz, Harry J. 
Ladd, C. Haven 
Lanman, Mrs. Thomas H. 
Lawrence, Mrs. John E. 
Lecn, Henry M. 
Lerman, Paul 



Lovejoy, George M., Jr. 
Low, Dr. Merritt B. 
Luce, Stephen C, Jr. 
Lyne, Daniel J., Jr. 
Macomber, C. Clark 
Markson, Robert T. 
Marzynski, Mrs. Julian A. 
McDevitt, Daniel J. 
Mcintosh, Harry R. 
Merriam, Mrs. Robert C. 
Minot, James J. 
Mock, Harold A. 
Moir, John A. 
Moody, Burt R. 
Morrissey, Francis X., Hon. 
Morrissey, Major Nicholas P. 
Murphy, Edward 
Newhall, Charles B. 
Newman, Stanley O. 
Niles, Harold L. 
Olmsted, George, Jr. 
Olmsted, J. Warren 
Parker, William A. 
Pease, Robert G. 
Perini, Louis R. 
Piper, Mrs. Richard F. 
Pitcher, Mrs. Robert B. 
Potter, Cary 
Pratt, Mrs. W. Elliott 
Precourt, Harry A. 
Preston, Richard 
Prouty, Richard 
Rice, Edmund 
Robie, Richard S. 
Rockett, Miss Emily 
Rosen, Gerald 
Rudd, Edward G. 
Shapiro, George 
Smith, Dr. Richard M. 
Smith, Sam 
Snow, William B. 
Southworth, W. Brewster 
Spence, W. Frederick 
Spring, John K. 
Stanbro, D. B. 
Stanwood, Geoffrey R. 
Stayman, Mrs. Bennett H. 
Steffian, Edwin T. 
Stockton, Charles H. 
Stockwell, Ernest F., Jr. 
Stone, Robert Gregg 
Sturgis, Edward, Jr. 
Sulloway, Frank J. 
Swift, Humphrey H. 
Tew, Mrs. John B. 
Thayer, Mrs. Sherman R. 
Thompson, George E., Flon. 
Tufts, John S. 



Tyler, Daniel, Jr. 
Tyler, Linscott 
Wallace, Mrs. Jacob 
Webster, Mrs. Edwin S. 
Weeks, Edward A., Jr. 
West, Richard S. 
Whalen, James V. 
Wheatland, Stephen 
Wheeler, Alexander, Jr. 
Wheeler, James G. 
White, Loren C. 
Whiteside, Howard S. 
Whitman, Mrs. Nehemiah H. 
Wilson, John J. 
Wolcott, Mrs. Samuel H., Jr. 
Wyman, Richard M. 



34 



THE CHILDREN'S HOSPITAL MEDICAL CENTER STAFF 1960 - 1961 



DEPARTMENT OF MEDICINE 

PHYSICIAN-IN-CHIEF 

Charles A. Janeway, M.D. 

ASSOCIATE CHIEF 

OF THE MEDICAL SERVICE 

Louis K. Diamond, M.D. 

General Medical Divisions 
Child Health Division 

Robert J. Haggerty, M.D. 

Medical Out-Patient Department 

Charles D. Cook, M.D. 

Adolescent Division 

J. Roswell Gallagher, M.D. 

Newborn Division 

Stewart H. Clifford, M.D. 

Infants' and Children's 
Medical Division 

William Berenberg, M.D. 

Private Medical Division 

John A. V. Davies, M.D. 

PHYSICIANS 

William Berenberg, M. D. 
Stewart H. Clifford, M.D. 
Charles D. Cook, M.D. 
John A. V. Davies, M.D. 
R. Cannon Elcy, M.D. 
Henry E. Gallup, M.D. 
Robert J. Haggerty, M.D. 
Alexander S. Nadas, M.D. 
David D. Rutstein, M.D. 
David W. Sherwood, M.D. 
Harry Shwachman, M.D. 
Clement A. Smith, M.D. 



ASSOCIATE PHYSICIANS 

Olga E. Allen, M.D. 
John K. Brines, M.D. 

John F. Crigler, Jr., M.D. 

Allen C. Crocker, M.D. 

James E. Drorbaugh, M.D. 

F.dward C. Dyer, M.D. 

Francis X. Fellers, M.D. 

Albert A. Frank, M.D. 

Park S. Gerald, M.D. 

David Gitlin, MIX 

Robert D. Gricsemcr, M.D. (m r.matoi.ogy) 



medicine continued 

Sprague W. Hazard, M.D. 

Allen M. Hill, M.D. 

John P. Hubbell, Jr., M.D. 

Samuel L. Katz, M.D. 

Sidney Kibrick, M.D. 

Robert T. Moulton, M.D. 

Maurice M. Osborne, M.D. to 7/31/60 

Richmond S. Paine, M.D. 

Murray Ethan Pendleton, M.D. 

William Pfeffer, M.D. 

Gertrud C. Reyersbach, M.D. 

Edward Manning Sears, M.D. 

Leonid S. Snegireff, M.D. 

William J. Turtle, M.D. 

John W. G. Tuthill, M.D. 

William D. Winter, M.D. 



ASSISTANT PHYSICIANS 

Donald M. Allen, M.D. 

Euan T. Blanch, M.D. 

T. Berry Brazelton, M.D. 

William D. Cochran, M.D. 

Albert Cohen, M.D. 

Kelley K. Davis, M.D. 

Karel deHaas, M.D. 

William A. Dickson, M.D. 

Elaine K. Donnellan, M.D. 

William R. Dorsey, M.D. 

Audrey E. Evans, M.D. 

Stephen M. Frawley, M.D. 

Sidney Green, M.D. 

Mildred Jefferson, M.D. 

Maurice N. Kay, M.D. 

Charles S. Keuper, M.D. (dermatology) 

Leon E. Kruger, M.D. 

Lucas L. Kulczycki, M.D. 

Alexander S. MacDonald, M.D. 

Campbell W. MacMillan, M.D. 

D. Hugh MacNamee, M.D. 

Lillian A. F. McMackin, M.D. 

Anna Mitus, M.D. 

Alice Nauen, M.D. 

Robert J. Orme, M.D. 

Joseph Osborne, M.D. 

Julian Pcarlman, M.D. 

Thomas C. Peebles, M.D. 

Howard J. Potter, M.D. 

Henry M. Putnam, M.D. 

John S. Robey, M.D. 

Herbert L. Ruben, M.D. 

Arthur J. Salisbury, M.D. 

James R. Sayre, M.D. 

Robert T. Scccry, M.D. 

Nasrollah T. Shahidi, M.D. 

Gerald B. Shattuck, M.D. 

Samuel Norman Sherry, M.D. 



medicine continued 

Allan E. Stimson, M.D. 
George H. Taft, M.D. 
Richard H. Watson, M.D. 
Harold J. Wheeler, M.D. 

RESEARCH ASSOCIATES IN MEDICINE 

Norman I. Gold, Ph.D. 
Ezio Merler, Ph.D. 

CLINICAL RESEARCH ASSOCIATE 
IN MEDICINE 

Miriam D. Manning, M.D. (tumor therapy) 

Adolescent Division 

CHIEF 

J. Roswell Gallagher, M.D. 

ASSOCIATE PHYSICIANS 

C. Cabell Bailey, M.D. 
Richard S. Eustis, M.D. 
Dana L. Farnsworth, M.D. 
Robert P. Masland, M.D. 
Walter W. Point, M.D. 
John A. Spargo, M. D. 

ASSISTANT PHYSICIANS 

Charles S. Gleason, M.D. 
Andrew D. Guthrie, M.D. 
Thomas J. Murphy, M.D. 
Frederick A. Pierce, Jr., M.D. 

RESEARCH ASSOCIATE 

Carl Seltzer, Ph.D. 

Child Health Division 
CHIEF 

Robert J. Haggerty, M.D. 

ASSOCIATE PHYSICIANS 

Ralph A. Ross, M.D. 
Abraham S. Small, M.D. 
Lcndon Sncdeker, M.D. 
Leon Stcrnfeld, M.D. 
Pauline G. Stitt, M.D. 

ASSISTANT PHYSICIANS 

Roger J. Meyer, M.D. 

Hcdwig Elizabeth Rose (Orncr), M.D. 

Eva J. Salbcr, M.D. 

Isabcllc Valadian, M.D. 



35 



medicine continued 

Special Medical Divisions 

Allergy Division 

ALLERGIST 

Harry L. Mueller, M.D. 

ASSISTANT ALLERGIST 

Irving W. Bailit, M.D. 

ASSISTANT PHYSICIANS 

Theodore Bennett, M.D. 
Frederick Blumenthal, M.D. 
George T. Critz, M.D. 
Elizabeth A. Gregory, M.D. 
Lawrence S. Morse, M.D. 
Otto S. Nau, M.D. 

Cardiology Division 

CARDIOLOGIST 

Alexander S. Nadas, M.D. 

ASSOCIATE CARDIOLOGISTS 

Walter T. Goodale, M.D. 
Anna J. Hauck, M.D. 
Benedict F. Massell, M.D. 

ASSISTANT CARDIOLOGISTS 

Albert Cohen, M.D. 
Joseph G. Cutler, M.D. 
Allen L. Friedlich, M.D. 
R. Greer Monroe, M.D. 
Jacob Wallace, M.D. 
Richard J. Waters, M.D. 
Richard Wolff, M.D. 
Alia Gergory Zaver, M.D. 

Good Samaritan Division 

CHIEF 

Charles A. Janeway, M.D. 

PHYSICIANS 

Edward F. Bland, M.D. 
Gabor Czoniczer, M.D. 
Allen L. Friedlich, M.D. 
Sprague W. Hazard, M.D. 
Benedict F. Massell, M.D. 
Sylvester McGinn, M.D. 
Alexander S. Nadas, M.D. 
Marian W. Ropes, M.D. 
David D. Rutstcin, M.D. 
George P. Sturgis, M.D. 
Edwin O. Wheeler, M.D. 
Conger Williams, M.D. 



medicine continued 

ASSISTANT PHYSICIAN 

Teogenes Carbonilla, M.D. 

Hematology Division 

HEMATOLOGIST 

Louis K. Diamond, M.D. 

ASSOCIATE HEMATOLOGIST 

Fred H. Allen, M.D. 

ASSISTANT HEMATOLOGISTS 

Donald M. Allen, M.D. 
Park S. Gerald, M.D. 

RESEARCH ASSOCIATE 

Mary Louise Efron, M.D. 

Neurology Division 

NEUROLOGIST 

Randolph K. Byers, M.D. 

ASSOCIATE NEUROLOGIST 

Richmond S. Paine, M.D. 

ASSISTANT NEUROLOGIST 

Simeon Locke, M.D. 

Seizure Unit 

ASSOCIATE NEUROLOGIST 

Cesare Lombroso, M.D. 

Director of 
Postgraduate Education 

R. Cannon Eley, M.D. 



DEPARTMENT OF PSYCHIATRY 

PSYCHIATRIST-IN-CHIEF 

George E. Gardner, Ph.D., M.D. 

PSYCHIATRISTS 

Tully Benaron, M.D. 
Lydia Dawes, M.D. 
Henry Wermer, M.D. 

ASSOCIATE PSYCHIATRIST 

Herbert I. Harris, M.D. 

ASSISTANT PSYCHIATRISTS 

children's hospital 

Graham Burt Blaine, M.D. 
John R. Blitzer, M.D. 
Dorothy M. Bollinger, M.D. 
Lawrence Claman, M.D. 
William M. Crowell, M.D. 
Chester C. D'Autremont, M.D. 
Hilda Effgen, M.D. 
Richard Galdston, M.D. 
Marvin Krims, M.D. 
William Earl Stone, M.D. 
Harold Wolman, M.D. 

JUDGE BAKER 

Ann Brown, M.D. 

John C. Coolidge, M.D. 

Richard Emerson, M.D. 

Alice Fleming, M.D. 

Thomas Frank, M.D. 

Dorothy Macnaughton, M.D. 

Elizabeth Makkay, M.D. 

Vera Tisza, M.D. 

Stanley Walzer, M.D. (as of 5>/l/60) 

John Weil, M.D. 

Lee M. Wilier, M.D. 

Bernard D. Woods, M.D. 

Joan Zilbach, M.D. 

PSYCHOLOGISTS 

children's hospital 

Joseph P. Lord, Ph.D., Chief 

Arnold Bookspun, M.A. 

Haskel Cohen, Ph.D. 

Miriam Fiedler, Ph.D. 

Margaret Ingram, M.A. 

Emma Kraidman, Ph.D. 

Sara Lee Moltz, M.A. 

Gcraldine Rickard, Ed.D. 

Celia Schulhoff, M.A. (as of 9/l/60) 

Edith Meyer Taylor, Ph.D. 

Albert Tricschman, Ph.D. 

Charles Woodbury, Ph.D. 

continued 



psychiatry continued 



JUDGE BAKER 



Bessie Sperry, Ph.D., Chief 

Pauline Hahn, Ph.D., Research Director 

Laura Heims, Ph.D. 

Irving Hurwicz, Ph.D. 

Arne Korstvedt, M.A. 

Norman Prentice, Ph.D. 

Edleff Schwaab, Ph.D. 

Ellen Tessman, Ph.D. 

Nicholas Verven, Ph.D. 

Samuel Waldfogel, Ph.D. 

Robert Young, Ed.D. 

RESEARCH ASSOCIATES 

Sidney Croog, Ph.D. 
Eric Lenneberg, Ph.D. 
Barbara K. Sutherland, Ph.D. 
Peter Wolff, M.D. 



DEPARTMENT OF SURGERY 

SURGEON-IN-CHIEF 

Robert E. Gross, M.D. 

SURGEONS 

Luther A. Longino, M.D. 
Donald W. MacCollum, M.D. 
Samuel R. Schuster, M.D. 
George W. B. Starkey, Jr., M.D. 

ASSOCIATE SURGEONS 

Thomas W. Botsford, M.D. 
John W. Chamberlain, M.D. 
Chilton Crane, M.D. 
Henry W. Hudson, Jr., M.D. 

ASSISTANT SURGEON 

W. Hardy Hendren, III, M.D. 

Anesthesia Division 

ANESTHESIOLOGIST 

Robert M. Smith, M.D. 

ASSOCIATE ANESTHESIOLOGISTS 

Mary Psaltopoulo, M.D. 
Anibal Salazar, M.D. 
John Stetson, M.D. 



DEPARTMENT OF 
OPHTHALMOLOGY 



OPHTHALMOLOGIST-IN-CHIEF 

Trygve Gundersen, M.D. 

ASSOCIATE OPHTHALMOLOGISTS 

Sumner D. Liebman, M.D. 
S. Forrest Martin, M.D. 

ASSISTANT OPHTHALMOLOGISTS 

Arthur F. Calnan, M.D. 
Alfred W. Scott, M.D. 



DEPARTMENT 
OF DENTISTRY 



DENTIST-IN-CHIEF 

Paul K. Losch, D.D.S. 

PEDODONTIST 

Charles L. Boycrs, D.M.D. 

ORTHODONTISTS 

Mclvin I. Cohen, D.M.D. 
LennarJ T. Swanson, D.M.D. 

ASSISTANT PEDODONTIST 

Terrence D. Hoover, D.M.D. 



DEPARTMENT OF 
OTOLARYNGOLOGY 

OTOLARYNGOLOGIST-IN-CHIEF 

Carlylc G. Flake, M.D. 

OTOLARYNGOLOGIST 

Charles F. Ferguson, M.D. 

ASSOCIATE OTOLARYNGOLOGIST 
(CHIEF E.N.T. OPD) 

John C. Trakas, M.D. 



Cleft Palate Dental Clinic 

ASSOCIATE ORTHODONTIST 

Edward I. Silver, D.M.D. 

ASSISTANT ORTHODONTISTS 

Henry C. Beebe, D.D.S. 
Emory Farrington, D.M.D. 
Abijah Pierce, D.M.D. 



Hearing and Speech Clinic 

DIRECTOR 

Adam J. Sortini, Ed.D. 



37 



DEPARTMENT OF 
ORTHOPEDIC SURGERY 

ORTHOPEDIC SURGEON-IN-CHIEF 

William T. Green, M.D. 

ORTHOPEDIC SURGEONS 

Jonathan Cohen, M.D. 
William A. Elliston, M.D. 
Paul W. Hugenbcrger, M.D. 
Arthur W. Trott, M.D. 

ASSOCIATE ORTHOPEDIC SURGEON 

Henry H. Banks, M.D. 

ASSISTANT ORTHOPEDIC SURGEONS 

Frank D. Bates, M.D. 
Paul P. Griffin, M.D. 
John G. Kuhns, M.D. 
Mihran O. Tachdjian, M.D. 

JUNIOR ASSISTANT 
ORTHOPEDIC SURGEON 

Alan Weiner, M.D. 



DEPARTMENT OF RADIOLOGY 

RADIOLOGIST-IN-CHIEF 
E. B. D. Neuhauser, M.D. 

RADIOLOGIST 

Martin Wittenborg, M.D. 

ASSOCIATE RADIOLOGIST 
(RADIOTHERAPY) 

Guilio J. D'Angio, M.D. 

ASSOCIATE RADIOLOGIST 

G. B. C. Harris, M.D. 



DEPARTMENT OF 
NEUROSURGERY 



NEUROSURGEON-IN-CHIEF 

Franc D. Ingraham, M.D. 

NEUROSURGEON 

Donald D. Matson, M.D. 

ASSOCIATE NEUROSURGEON 

Edgar A. Bering, Jr., M.D. 

ASSISTANT NEUROSURGEON 

John Shillito, M.D. 



DIVISION OF LABORATORIES 
AND RESEARCH 

CHAIRMAN 

Sidney Farber, M.D. 

Department of Pathology 

PATHOLOGIST-IN-CHIEF 

Sidney Farber, M.D. 

PATHOLOGIST 

Gordon F. Vawter, M.D. 

ASSOCIATE PATHOLOGISTS 

Betty Q. Banker, M.D. (Neurology) 
Jonathan Cohen, M.D. (Orthopedics) 

RESEARCH ASSOCIATES 

Richard A. Adams, Ph.D. 

Rogelio A. Alarcon, Ph.D. 

Sherman Beychok, Ph.D. 

Stanley M. Bloom, Ph.D. 

Elkan R. Blout, Ph.D. 

Ornella Calabi, Sc.D. 

Giuliana Cardinali, D.Sc. 

Giuseppe Cardinali, M.D. 

Donald L. D. Caspar, Ph.D. 

Suprabhat Chatterjee, Ph.D. 

Elizabeth F. Claflin, Ph.D. 

Carolyn Cohen, Ph.D. 

J. LeRoy Conel, Ph.D. 

Allen C. Crocker, M.D. 

Isaac Djerassi, M.D. (until 7/31/60) 

Samuel S. Epstein, M.D. 

Gerald D. Fasman, Ph.D. 

Shou-Cheng J. Fu, Ph.D. 

Alfred H. Handler, Ph.D. 

Kenneth C. Holmes, Ph.D. 

Mervyn Israel, Ph.D. 

Lawrence Kingsland, M.D. (biometrics) 

Edmund Klein, M.D. 

Ramchandra K. Kulkarni, Ph.D. 

Livia Hedvig Rev Kury, M.D. 

Cecilie Leuchtenberger, Ph.D. 

Rudolf Leuchtenberger, M.D. 

Arlene C. Longwell, Ph.D. 

Susan Lowey, Ph.D. 

Robert E. McCarthy, Ph.D. 

Charlotte L. Maddock, M.D. 

Edward J. Modest, Ph.D. 

Marion F. Narrod, Ph.D. 

Carl R. Partanen, Ph.D. 

Elizabeth R. Simons, Ph.D. 

Kyoko Tanaka, Sc.D. 

Tatsuya Tanaka, Sc.D. 

Betty G. Uzman, M.D. 

Donald B. Wetlaufcr, Ph.D. 

Laurens P. White, M.D. 

George Yerganian, Ph.D. 



laboratories and research continued 

RESEARCH ASSISTANTS 

Virginia Binns, Sc.B. 
Christianne T. DeLoze, Sc.D. 
Beatrice P. Drolet, Sc.B. 

Laboratory of Clinical Pathology 
CHIEF 

Harry Shwachman, M.D. 

BACTERIOLOGIST 

George E. Foley, Sc.D. 

RESEARCH ASSOCIATES 

Irena Antonowicz, M.Sc. 
John T. Clarke, Ph.D. 
Morris N. Green, Ph.D. 

RESEARCH ASSISTANT 

Eva Fekete, M.D.* 

Research Division 

of Infectious Diseases 

CHIEF 

John F. Enders, Ph.D. 

RESEARCH ASSOCIATES 

Samuel L. Katz, M.D. 
Sidney Kibrick, M.D. 

Tumor Therapy Division 

PHYSICIANS 

William Berenberg, M.D. (See Medicine) 

Audrey E. Evans, M.D. 

Harry Shwachman, M.D. (See Medicine) 

Leonid S. Snegireff, M.D. 

Laurens P. White, M.D. 

ASSISTANT PHYSICIANS 

Mildred F. Jefferson, M.D. (to 12/31/60) 
Anna Mitus, M.D. 

RADIOTHERAPIST 

Giulio J. D'Angio, M.D. (See Radiology) 

CLINICAL RESEARCH ASSOCIATE 
IN MEDICINE 

Miriam D. Manning, M.D. 



'Deceased 



38 



CONSULTANTS 



EMERITI 



MEDICINE 

Benjamin Alexander, M.D. 

COMPARATIVE PATHOLOGY 

Donald L. Augustine, M.D. 

DENTISTRY 

Harry K. Bailey, D.M.D. 

ORTHOPEDIC SURGERY 

Joseph S. Barr, M.D. 

UROLOGY 

Hathorn P. Brown, M.D. 

OPHTHALMOLOGY 

Paul A. Chandler, M.D. 

DERMATOLOGY 

Austin W. Cheever, M.D. 

NEUROLOGY 

Stanley Cobb, M.D. 

OPHTHALMOLOGY 

David G. Cogan, M.D. 

PATHOLOGY 

Gustave E. Dammin, M.D. 

MICROBIOLOGY 

Bernard D. Davis, M.D. 

PSYCHIATRY 

Felix Deutsch, M.D. 

MEDICINE 

Lewis Dexter, M.D. 

OPHTHALMOLOGY 

Edwin B. Dunphy, M.D. 

MEDICINE 

Kendall Emerson, M.D. 

PHYSIOLOGY 

Benjamin G. Ferris, M.D. 

ANESTHESIOLOGY 

Jacob Fine, M.D. 

MEDICINE 

Sydney S. Gellis, M.D. 

UROLOGY 

J. Hartwell Harrison, M.D. 

pa mm OGY 

Arthur Hertig, M.D. 

DERMA TOLOGY 

William R. Hill, M.D. 

PA I IIOI.OCY 

Oscar Hirscli, M.D. 

AN I HROPOl (X.Y 

William W. Howells, Ph.D. 

OR i HOPEDIC SURGERY 

Meier S. K.irp, M.D. 

INI I ( i iocs DIS1 ase 
Edward Kiss, M.D. 
[>i n ; I ISIRY 
Owen W. Kile, D.M.D. 



PHARMACOLOGY 

Otto Krayer, M.D. 

PHYSIOLOGY 

Eugene M. Landis, M.D. 

EDUCATION 

Edward Landy, Ed.D. 

MEDICINE 

Samuel A. Levine, M.D. 

RADIOLOGY 

Joseph Marks, M.D. 

NUTRITION 

Jean Mayer, Ph.D., D.Sc. 

PATHOLOGY 

William Meissner, M.D. 

SURGERY 

Francis D. Moore, M.D. 

OBSTETRICS 

Duncan Reid, M.D. 

CHILD HEALTH 

William M. Schmidt, M.D. 
Herbert Selenkow, M.D. 

OPHTHALMOLOGY 

Albert E. Sloane, M.D. 

RADIOLOGY 

Magnus Smcdal, M.D. 

NUCLEAR MEDICINE 

Arthur Solomon, M.D. 

GYNECOLOGY 

Somers H. Sturgis, M.D. 

PREVENTIVE MEDICINE 

Carl E. Taylor, M.D. 

NEOPLASTIC DISEASES 

Grantley Taylor, M.D. 

MEDICINE 

George W. Thorn, M.D. 

SURGERY 

Carl W. Walter, M.D. 

PATHOLOGY 

Shields Warren, M.D. 

INFECTIOUS DISEASES 
Louis Wcinstcin, M.D. 

STOMATOLOGY 

David Wcisbcrger, M.D. 

PARASITIC AND VIRAL DISEASES 

Thomas H. Wellcr, M.D. 

PHYSIOLOGY 

James L. Whittenberger, M.D. 

Nl UROPA1 HOLOGY 
Paul Yakovlcv, M.D. 



ORTHOPEDIC SURGEON, EMERITUS 

Albert H. Brewster, M.D. 

CONSULTANT IN MEDICINE, EMERITUS 

C. Sidney Burwell, M.D. 

CONSULTANT IN MEDICINE, EMERITUS 

Allan M. Butler, M.D. 

CONSULTANT IN CHILD HEALTH, EMERITUS 

Martha M. Eliot, M.D. 

CONSULTANT IN RADIOLOGY, EMERITUS 

Albert Ferguson, M.D. 

PHYSICIAN, EMERITUS AND ALLERGIST, EMERITUS 

Lewis W. Hill, M.D. 

PHYSICIAN, EMERITUS 

Eliot Hubbard, Jr., M.D. 

SURGEON-IN-CHIEF, EMERITUS 

William E. Ladd, M.D. 

SURGEON, EMERITUS 

Thomas H. Lanman, M.D.* 

ORTHOPEDIC SURGEON, EMERITUS 

Robert H. Morris, M.D. 

CONSULTANT IN SURGERY, EMERITUS 

Charles G. Mixter, M.D. 

CONSULTANT IN SURGERY, EMERITUS 

Francis C. Newton, M.D. 

ORTHOPEDIC SURGEON-IN-CHIEF 

Frank R. Ober, M.D.* 

CONSULTANT IN OTOLARYNGOLOGY, EMERITUS 

Leroy A. Schall, M.D. 

ORTHOPEDIC SURGEON, EMERITUS 

James W. Sever, M.D. 

PHYSICIAN-IN-CHIEF, EMERITUS 

Richard M. Smith, M.D. 

CONSULTANT IN CHILD HEALTH, EMERITUS 

Harold C. Stuart, M.D. 

CONSULTANT IN OPHTHALMOLOGY, EMERITUS 

Frederick A. VcrhoerT, M.D. 

CONSULTANT IN INFECTIOUS DISEASES, EMERITUS 

Conrad Wesselhoeft, M.D. 

PHYSICIAN, EMERITUS 

Edwin T. Wyman, M.D. 
* Deceased. 







^ *J 



**- 



W^al 



*X 




>*i 



£ _ 



41 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



In Memoriam 43 



Report of Physician-in-Chief 45 

Report of Surgeon-in-Chief 59 

Report of Anesthesiologist 62 

Report of Orthopedic Surgeon-in-Chief 65 

Report of Neurosurgeon-in-Chief 73 

Report of Psychiatrist-in-Chief 79 

Report of Radiologist-in-Chief 89 



Division of Laboratories and Research 93 



Department of Otolaryngology 113 
Department of Dentistry 115 



Department of Ophthalmology 116 



43 



IN MEMORIAM 



On December 25, 1959, Dr. J. Lewis Bremer, embryologist, who 
worked in the Pathology Department for eighteen years, died at the age 
of eighty-five. 

On July 21, 1960, Dr. William G. Lennox died. Dr. Lennox, who 
was seventy-six years old, was the founder of our Seizure Unit and a 
pioneer in the study of epilepsy and the crusade for social enlightenment 
regarding victims of this disease. Further comment may be found in the 
Physician-in-Chief's report. 

On October 4, 1960, Dr. David S. Grice was killed in an airplane 
accident at Logan Airport. Dr. Grice, who was forty-six years old, came 
to The Children's Hospital for training and was a member of the staff 
from 1944 to 1958, when he left to accept the appointment of Professor 
of Orthopedic Surgery at the University of Pennsylvania. His friends 
and former patients have contributed approximately $8,000 for a Grice 
Memorial Fund at The Children's Hospital. 

On December 26, 1960, Dr. Frank Ober died at the age of seventy- 
nine, after a brief illness. Orthopedic Surgeon-in-Chief for fifteen years 
prior to his retirement in 1946, Dr. Ober was a member of The Chil- 
dren's Hospital staff from 1913 until his death. A clinical Professor of 
Orthopedic Surgery at Harvard Medical School and former Assistant 
Dean, he established the Frank Ober Orthopedic Research Fund at this 
Hospital in 1941. 



45 



DEPARTMENT OF MEDICINE 



REPORT OF 
PHYSICIAN-IN-CHIEF 



SERVICES TO PATIENTS 

The significant changes in the charac- 
ter and volume of the Center's services 
to children are nowhere revealed more 
plainly than in a comparison of the 
operations of the Medical Department 
in the year ending September 30, 
I960, with its operations in previous 
years. A study of the table on page 46, 
showing the estimated volume of serv- 
ices in the current year, discloses strik- 
ing differences, and impressive growth 
and suggests the existence of definite 
needs. Certain trends are unmistak- 
able. Out-patient or Ambulatory Serv- 
ices have grown strikingly in volume, 
by 72 per cent since 1946-47, by 36 
per cent over the past four years. This 
growth of ambulatory services reflects 
three processes of change: (a) the 
development of new services, such as 
the Child Health Unit and the Adoles- 
cent Unit; (b) an extraordinary ex- 
pansion in the activities of the Medical 
Emergency Clinic, which has become 
the largest medical clinic; and (c) an 
increase in the case load of certain 
special clinics, particularly the Cardiac 
Clinic. While this growth has oc- 
curred, there has been a decline in the 
activity of the general Medical Out- 
patient Clinic, which mainly reflects 
the development of adequate facilities 
and staff for the management of acute 
illness in the Medical Emergency 
Clinic. 

Over the same period, there have 
been equally important changes in the 
volume and character of our In-patient 
Services. While this number of admis- 
sions to the acute services has risen by 
32 per cent since 1946-47, the number 
of hospital days of care has declined 
by 46 per cent, a trend which is re- 
flected in a much shorter average 
length of stay of 34 per cent. For all 
medical in-patient services over the 
past thirteen years, the number of ad- 



missions has risen by 29 per cent, and 
the number of hospital days has de- 
clined by 45 per cent. All this shows 
why we have been able to care for 
more children in the hospital with 
fewer medical beds, and also why, with 
a high turnover of sick patients, more 
personnel are needed and costs have 
risen. These changes presumably re- 
flect better medical care and a higher 
standard of living in the community, 
population trends, and improved meth- 
ods of treatment in the hospital. It is 
interesting that hospital admissions 
have been rising despite virtual elim- 
ination of poliomyelitis as a major dis- 
ease requiring hospital care. However, 
it seems likely that the trend of rising 
admissions will continue only if we 
draw from an increasingly large popu- 
lation base or provide more extensive 
services to the low-income groups 
moving into the city from the South 
and from Puerto Rico. The incidence 
of disease is high among such groups 
because of poor socio-economic con- 
ditions. 

On the medical services last year 
there were 159 deaths. Although the 
Medical Services care for children of 
all ages up to twenty years, 59 per cent 
of all deaths occurred in newborn in- 
fants and 78 per cent in newborns and 
infants under three years. These fig- 
ures emphasize the well-known fact 
that the bulk of childhood mortality is 
in infancy and particularly in the first 
month of life, and that its principal 
causes are congenital malformations, 
particularly of the heart, and perinatal 
disease. 

The Medical Service as a whole may 
be thought of as a large and complex 
pediatric practice, the services being 
given by a large group rather than by 
a single physician. It includes, in dif- 
ferent proportions to be sure, all the 
functions of a practicing physician, as 
follows : 



46 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Health supervision of children and 
home visits to sick children. These 
two prime functions of the prac- 
ticing physician are provided to a 
selected group of families through the 
Child Health Unit and its Family Care 
Program, not because such services are 
lacking in the community but because 
they offer invaluable experience for 
education of the future physician and 
provide a small pediatric practice 
within which research upon many as- 
pects of family medicine can be car- 
ried on. 

Twenty-four-hour emergency service. 
The Medical Emergency Clinic pro- 
vides this service. Closely integrated 
with it is the Poison Information Cen- 
ter, which provides information for 
physicians and parents upon the in- 
gredients, toxicity, and recommended 
treatment for any chemical substance 
ingested accidentally by a child. 



Hospitalization for illness. The In- 
patient Service provides this care. 
Consultation for less acute illness. 
This major service is available on ap- 
pointment for children up to twelve 
years of age in the Medical Out- 
patient Department and for children 
over twelve years in the Adolescent 
Unit, and occasionally by admission to 
the wards for study. 
Long-term medical supervision and re- 
habilitation of children with chronic 
illnesses. These services are primarily 
the function of the various special clin- 
ics staffed by the same group of doctors. 
Regular attendance at a special clinic 
with particular knowledge of the dis- 
ease provides the continuity in care 
and in doctor-patient relationship 
which is so important in treating chil- 
dren with chronic disease. Usually 
the day by day medical care of the 
child is provided by the family physi- 



cian, the long-term management of 
disease being directed by the Hospital 
Staff. 

These last four are essential serv- 
ices filling a very real need. In a sense, 
The Children's Medical Center func- 
tions as three hospitals in one: as a 
community hospital serving the gen- 
eral medical needs of a considerable 
group of children in the Greater Bos- 
ton area; as a regional hospital pro- 
viding consultation service for physi- 
cians and community hospitals in the 
New England area; and a final court 
of appeal for distraught families who 
may come for help with a sick child 
from anywhere in the world. These 
last two functions are what make The 
Children's Hospital Medical Center a 
unique institution. They depend pri- 
marily on the extraordinary diversity 
of talent, on the tremendous experi- 
ence of the staff and on the unique 



VOLUME OF SERVICES 


















OUT-PATIENT SERVICES 














Per cent < 


:hange since 


(Total Visits) 


1946-47 


1951-52 


1956-57 


1957-58 


1958-59 


1959-60* 


1946-47 


1956-57 


ALL MEDICAL CLINICS 


24,360 


24,425 


30,939 


31,156 


38,622 


(41,977) 


+72% 


+36% 


Child Health Unit 








2,839 


2,146 


3,105 


(3,081) 


— 


— 


Medical Emergency 





4,798 


5,506 


5,422 


12,274 


(14,450) 


— 


— 


General Medical OPD 


13,470 


7,922 


7,701 


6,595 


6,693 


(6,322) 


— 


— 


Adolescent Unit 





600 


4,827 


5,116 


5,249 


(5,897) 


— 


— 


Special Clinics 


10,890 


11,705 


10,057 


10,991 


11,901 


(12,227) 


— 


— 


IN-PATIENT SERVICES 


















Acute Services 


















Admissions 


2,261 


3,326 


2,917 


2,818 


3,417 


(3,312) 


+32% 


+ 12% 


Hospital Days 


33,926 


29,039 


26,484 


27,189 


27,834 


(26,796) 


—21% 


+ 1% 


Average Stay (Days) 


15 


8.7 


8.4 


9.6 


8.1 


(8.1) 


—46% 


— 3% 


Chronic Services 


















Admissions 


464 


443 


253 


189 


208 


(218) 


—53% 


—13% 


Hospital Days 


32,692 


29,682 


20,757 


13,451 


10,189 


(10,111) 


—70% 


—50% 


Average Stay (Days) 


70 


67 


82 


71 


50 


(46) 


—34% 


—AA% 


TOTAL IN-PATIENT 


















Admissions 


2,725 


3,769 


3,270 


3,007 


3,679 


(3,530) 


+29% 


+ 8% 


Hospital Days 


66,618 


58,721 


47,241 


40,640 


38,023 


(36,907) 


—45% 


—22% 


* Figures for 1959-60 estimated as basis 


of 11 months' experience for Out 


-Patient Services and on basis of 


10 months' 


experience for In-Patient Services. All 


estimates in 


parenthesis. 













47 



DEPARTMENT OF MEDICINE 



laboratory, X-ray and surgical facili- 
ties which have been built up through 
the years to meet the specific needs of 
children. Although this is a report of 
the Medical Department, it cannot be 
emphasized too strongly that by itself 
our department would amount to 
little. It is the support of the other 
clinical departments, including Radi- 
ology, the expert technical and scien- 
tific personnel and facilities available 
in the Division of Laboratories and 
Research, the skill and devotion of our 
nurses, and the conscientious efforts of 
all the supporting service departments 
that give The Children's strength. 

One thing is clear: consulting 
practice has moved from the office of 
a single experienced and wise physi- 
cian to institutions such as ours. It is 
as a specialized consultation and treat- 
ment center for children that The 
Children's Hospital Medical Center 
will fulfill its unique purpose. For 
such a development we need men of 
great ability who can devote their full 
time to this task. This requires money, 
but money is not too difficult to ob- 
tain, provided we select outstanding 
people. At present our need is for 
facilities for clinical and investigative 
work which will attract and hold able 
people at this institution. The short- 
age of suitable facilities — well- 
organized office, clinic and research 
laboratory space — is becoming a very 
serious handicap to progress in the 
direction along which historical neces- 
sity leads us and which offers the 
greatest chance of solid financial sup- 
port in the future. 

In discussing services to patients, 
we should not forget the very appre- 
ciable portion of staff devoted to giv- 
ing professional advice to parents, to 
colleagues, and to practicing physi- 
cians. Scarcely a day goes by when a 
member of the full-time staff does not 
advise some doctor by long-distance 



telephone or write one or two letters 
in answer to requests for information 
about a sick child. Could these hidden 
services be counted, their volume 
would be surprising. 



EDUCATION 

Medical students 

The pediatric education of students 
from the Harvard Medical School con- 
tinues to be a very important responsi- 
bility of the department. Although a 
constant effort is being made to im- 
prove the quality of our teaching, no 
major change will be possible until 
there is a general revision of the clini- 
cal curriculum of the Medical School. 
An attempt is being made, within the 
limitations of the allotted time, to give 
the students greater contact with the 
diversity of special knowledge in 
pediatrics and the wealth of clinical 
material to be found in The Children's 
Hospital Medical Center. 



House staff 

The Medical House Staff is large. It 
consists of the following groups: 
twenty-six on the regular in-patient 
house staff, eight to eleven on the out- 
patient house staff, and three to five 
filling a resident's function in Neu- 
rology, Cardiology, and Tumor 
Therapy as part of their training in 
that special field of pediatrics. Last 
year approximately 250 applicants 
were processed for the thirty-four ap- 
pointments made. It is a shameful 
fact that this institution is the only 
teaching hospital in Boston, and quite 
possibly the only one in the country, 
that does not pay a reasonable stipend 
to all of its house officers; that the 
niunber and quality of the applicants 
should be what they are is gratifying. 



Postgraduate students 

Ever since the war, under Dr. R. Can- 
non Eley's direction, the Department 
has run a four months' postgraduate 
course under the aegis of the Courses 
for Graduates, Harvard Medical 
School. Starting as a refresher for re- 
turning veterans, the course now has 
become primarily an introduction to 
American pediatrics for foreign stu- 
dents, most of whom have gone on 
from our course to further clinical 
training after becoming familiar with 
our ways of doing things. In this 
respect, I believe it has played a very 
useful role, but one which we hope 
to improve still further. 

Training for research 

The vast increase in funds to support 
medical research since the war, as well 
as the expansion in the number and 
size of medical schools, has created a 
tremendous demand for people with 
proper training to undertake academic 
careers of teaching and research. In 
addition, the tremendous prestige of 
American medicine has brought many 
able young teachers to this country 
from abroad for a period of research 
training. Although training for re- 
search has always been an important 
function of this institution and of our 
department, particularly under the late 
Dr. James L. Gamble, it has grown 
greatly in size and importance since 
the war. 

For example, during the year 
covered by this report, a total of 114 
individuals, of whom sixty-five were 
U. S. citizens from twenty-four states, 
and forty-nine citizens of twenty-nine 
different foreign countries, enrolled in 
one or another training program in 
this department. This number in- 
cludes those on the house staff, but 
more than half were in research 
training. 



48 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



With the support of training 
grants from the National Institutes of 
Health of the U. S. Public Health 
Service, formal training programs for 
clinical investigative careers have been 
inaugurated in Cardiology, Hema- 
tology, Neurology, and in General 
Pediatrics with a strong focus on 
metabolism. These grants are a very 
hopeful development. They not only 
provide additional support for staff, 
but place the responsibility for selec- 
tion of trainees upon the institution, 
which usually knows the applicants, 
instead of leaving it to a committee 
which does not. 

RESEARCH 

Research is an essential function of the 
department, not a luxury. Since this 
hospital attracts such a wealth of cases 
of unusual diseases, we have a particu- 
lar responsibility to see that the unique 
opportunity so provided is used to ob- 
tain the knowledge from which alone 
better understanding and improved 
treatment can come for children every- 
where. 

Research is basically an individual 
matter — it starts as a creative process 
in the minds of gifted, imaginative, 
curious and observant people. But it 
requires hard, systematic, disciplined 
work to test the validity of hypotheses. 
Moreover, since the problems of disease 
can be solved only by bringing basic 
knowledge from the natural and medi- 
cal sciences to bear on them through 
the application of a variety of new 
techniques, close collaboration between 
interested scientists and clinicians with 
scientific training and understanding is 
vital. Thus, while departmental organ- 
ization and clear lines of authority and 
responsibility are important in the clin- 
ical, educational, and administrative 
work of the department, great flexi- 
bility in arrangements and opportuni- 
ties to cross the boundaries of depart- 



ments and disciplines are equally de- 
sirable for the promotion of research 
by its members. Boston is a particu- 
larly happy place in this regard. 

Given the presence of an able, 
well-trained, curious physician and the 
unique opportunities at The Chil- 
dren's Hospital Medical Center to 
study disease in children and to col- 
laborate with the great variety of sci- 
entists both within and outside this 
institution in the Boston area, what is 
needed to make him a productive 
clinical investigator? I believe there 
are four essential needs which must 
be met: (1) Time, (2) Security, 
(3) Funds, (4) Facilities. 

Time 

Research requires thought, reading, 
reflection, and labor, all time-consum- 
ing. The full-time system was designed 
to meet this requirement, freeing a 
man of the necessity of devoting most 
of his time to earning his living in 
practice. 

Security 

Most clinical investigation depends 
upon attracting and holding together 
a group of patients the investigator 
desires to study. The organization of 
such a team with proper financial sup- 
port takes a number of years. Thus, 
a frequent turnover of staff in a clini- 
cal department is wasteful. To hold 
people, an opportunity to work on a 
long-term basis is essential. We need 
funds to underwrite several people in 
the department on a permanent basis, 
so that they can devote a life time to 
the study of a particular area. 

Funds 

Funds are necessary to provide time 
and security for the investigator, to 
support his laboratory group and to 
pay for the expenses of hospitalization 



or clinic care of patients under investi- 
gation. For the past few years this de- 
partment has been exceedingly fortu- 
nate in having a very generous grant 
of approximately $100,000 per year 
from the John A. Hartford Founda- 
tion, which provides for the expenses 
of hospitalization for research study 
and treatment of patients with dis- 
orders of protein synthesis, with par- 
ticular emphasis upon diseases of the 
blood. This grant has greatly increased 
our opportunity to study patients in 
the hospital, without hardship to the 
patient or drain on the Hospital's re- 
sources. The extent to which special 
funds for research from various 
sources, particularly the National In- 
stitute of Health, support our work 
will be apparent in the section de- 
voted to the financial affairs of the 
department. 

Facilities 

Clinical investigation, particularly in 
a teaching hospital such as ours, re- 
quires adequate out-patient clinic 
space where ambulatory patients can 
be followed, ward space where special 
studies may be carried out, with offices 
and laboratory space for the investi- 
gators as close as possible to the wards 
or clinic area. At present, the research 
laboratories of the department's eleven 
research groups are in nine different 
buildings. In only a few instances are 
the amount and type of space adequate 
for its purpose, and there is no space 
at present suitable for laboratories for 
neurological research. Thus, the re- 
search laboratory facilities of the De- 
partment are scattered, poorly situated, 
and inadequate, both qualitatively and 
quantitatively. The Clinical Research 
Building was carefully planned to 
remedy many of these deficiencies; on 
the basis of these plans approximately 
$750,000 was obtained from the Na- 
tional Institutes of Health and a lot 



49 



DEPARTMENT OF MEDICINE 



more money raised from the public. 
The construction of this building is an 
urgent necessity, unless the Hospital 
is to lose its position of leadership and 
much of the grant money which it 
needs to support its total program, 
not only of research but of teaching 
and care of children as well. These 
functions are inextricably intertwined. 
If we slip in one of them, we shall 
slip in all. 

FINANCIAL 

An analysis of the source and amount 
of money spent on salaries of the pro- 
fessional, technical and clerical staff 
under the administrative supervision 
of the department underscores what 
has happened over the 37 years for 
which we have records: first an enor- 
mous increase in total budget, with a 
very small increase in the "hard" 
money resources of the department; 
second, the tremendous increase in 
money from gifts and grants, account- 
ing for 77 per cent of the total budget; 
and third, the greatly increased ad- 
ministrative burden placed upon those 
responsible for this many people and 
this much money derived from so 
many different sources. 

"Hard" money is needed to pro- 
vide security for the key members of 
the full-time staff. It is to be hoped 



that the Harvard Medical Center Fund 
drive will help to meet this need. 
There is no better investment in the 
future strength of the Hospital. 

The increase in gifts and grants 
and the administrative burden which 
they impose, together with the growth 
in size and complexity of the depart- 
ment, made us feel the necessity for 
an administrative reorganization 
within the department. We were for- 
tunate in being able to secure the half- 
time services of Mr. George L. 
Batchelder, Jr., starting July 1, I960. 
With his experience as Business Man- 
ager of Protein Foundation since 1954 
and as Business Manager of the Bay 
State Clinic for Rehabilitation, he 
understands the complexities of the 
budgetary arrangements of this depart- 
ment. 

Analysis of the special funds 
available for the work of the depart- 
ment is shown in the table below. 

These very large sums are not 
only evidence of the reputation which 
the Staff of this Hospital enjoys but 
also of the hard work of the many staff 
members required to obtain these 
many gifts and grants to support the 
work of the institution. Further in- 
creases in the amounts of money avail- 
able for the extramural research pro- 



SPECIAL FUNDS — DEPARTMENT OF MEDICINE 

(Salary Budget Only) 

HOSPITAL 

Special funds — private sources $312,584 

Grants from National Institutes of Health 245,314 

Total Special Funds (Hospital) $557,898 

HARVARD 

Special funds — private sources 47,206 

Grants from National Institutes of Health 103,620 

Total Special Funds (Harvard) 150,826 

Total, all Special Funds $708,724 

Total Special Funds from private sources $359,790 

Total Special Funds from government (N.I.H.) sources $348,934 



grams of the National Institutes of 
Health, and changes in their grant- 
making policies to extend the terms 
of grants, to broaden the type of sup- 
port for programs more than projects, 
and to permit consolidation of several 
grants into one, which are mainly the 
result of Dr. Sidney Farber's efforts 
as a member of the National Advisory 
Health Council, have been enormously 
helpful to investigators throughout the 
country and suggest that more and 
more of our research will be supported 
from the National Institutes of Health. 
However, the size of the figure for 
gifts from private sources should re- 
assure those who fear that govern- 
mental support of research would dis- 
courage private giving. 

PERSONNEL 

During a period of fourteen months, 
death has taken three of the great 
figures who helped to give The 
Children's Hospital Medical Center its 
world-wide reputation. Dr. James L. 
Gamble, whose lifetime devoted "to 
the study of disease by the methods 
of chemistry" affected the care of 
patients in almost every branch of 
medicine and helped to save countless 
lives, died in May, 1959. Dr. Bronson 
Crothers, whose pioneering effort to 
understand the basis and management 
of neurological disease and particu- 
larly cerebral palsy in children, died at 
his summer home in Sorrento, Maine, 
in July, 1959. His book The Natural 
History of Cerebral Palsy based on his 
life's work, was just completed, and 
he had received word only two months 
before of his selection to receive the 
John Howland Award of the Ameri- 
can Pediatric Society. Warm, kindly, 
modest, humorous, and iconoclastic, 
his influence upon pediatrics, and par- 
ticularly upon the long succession of 
house officers who served as his "ap- 
prentices" during part of their train- 



50 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



ing at The Children's Hospital, will 
last for many years. Another great 
figure in child neurology, Dr. William 
G. Lennox, whose life was devoted to 
the study of epilepsy and who fought 
courageously for better treatment for 
the epileptic by society, died in July, 
I960. Dr. Lennox came to the Hospi- 
tal immediately after the war, found- 
ing the Seizure Unit, where many 
troubled parents found comfort and 
expert help and here many physicians 
have been trained in the total care of 
patients with epilepsy. He too had 
just completed his major book on 
epilepsy. He had just received the 
first specially bound copy from his 
publisher to the affectionate applause 
of hundreds of physicians, patients 
and friends gathered in the Harvard 
Club last July for "An Evening with 
Dr. Lennox," when the ultimately fatal 
cerebral accident began. The diag- 
nosis and study of epilepsy have been 
enormously advanced by his applica- 
tion of electroencephalography with 
Gibbs. He combined the attributes of 
a scholar with the fervor of a mis- 
sionary in his attack upon "the falling 
sickness," and every epileptic is his 
beneficiary. 

Two important awards came to 
members of the staff this past year. 
At an impressive ceremony in May, 
I960, at Swampscott, the John How- 
land Award of the American Pedia- 
tric Society was given posthumously 
to Dr. Crothers for his distinguished 
services to pediatrics, with tribute be- 
ing read by a former house officer, Dr. 
Edward L. Pratt, now Professor of 
Pediatrics at Southwestern Medical 
College, Dallas, Texas, and by Dr. 
Randolph Byers of our staff. Dr. 
Harold C Stuart, the founder of our 
Child Health Division and emeritus 
Professor of Child Health at the Har- 
vard School of Public Health, received 
the Borden Award of the American 



Academy of Pediatrics at its meeting 
in October 1959. These are the two 
major awards in American pediatrics. 

Two members of our staff have 
left to assume positions of greater re- 
sponsibility. Dr. Abraham M. 
Rudolph, who came to us from South 
Africa in 1950 and who rose from 
Research Fellow to Associate Cardiol- 
ogist, has gone to the Albert Einstein 
Medical College, Bronx, New York, as 
Associate Professor of Pediatrics in 
charge of their cardiovascular work. 
Dr. Felix P. Heald, who served here 
first as a resident on the Tumor 
Therapy Service and then was closely 
associated with Dr. J. Roswell Gal- 
lagher from the inception of the 
Adolescent Unit, has gone to the Chil- 
dren's Hospital of Washington, D. C, 
to take charge of their Adolescent 
Division and their program of Post- 
graduate Education. Each of these men 
is a loss to us, but it is through such 
successive losses and renewals that 
The Children's Hospital makes one of 
its major contributions to the develop- 
ment of pediatrics in this country. 

Many members of the staff con- 
tribute in a great variety of ways to 
the public welfare — as trustees, com- 
mittee members and chairmen and 
advisors to private and governmental 
organizations in their own commu- 
nities, in the Commonwealth of 
Massachusetts, and in the nation as a 
whole. Five staff members serve in an 
editorial capacity on important medi- 
cal journals; one, Dr. Clement Smith, 
has been Chairman of the Pediatric 
Section of the American Medical Asso- 
ciation, and another serves on the Ex- 
ecutive Board of the International 
Pediatric Association. This is no 
ivory tower, but an institution whose 
members are deeply involved both as 
experts and as good citizens in the life 
of this country. 

Moreover, this activity no longer 



stops at our national borders. In the 
past year members of our staff have 
been on professional missions to Den- 
mark, Sweden, Holland, England, 
Switzerland, Poland, and India. In 
fact, one member, Dr. Richmond S. 
Paine, has flown to England twice this 
summer by request to participate in 
international meetings on cerebral 
palsy. The bonds which link together 
those with a common interest in child 
health throughout the world have be- 
come as strong and as close as those 
which tie us to colleagues in other 
parts of our own country. The inter- 
national character of pediatrics was 
particularly apparent last summer 
when we had the pleasure of playing 
host to a stream of visitors before 
and after the International Paediatric 
Congress in Montreal, at which many 
members of our staff played a promi- 
nent role and the President of which, 
Dr. Alan Ross, was a former house 
officer. Last year 145 visitors from 
forty-five countries came to visit the 
Department. 

ACTIVITIES OF THE MEDICAL 
DIVISIONS 

Child Health Division 

Under Dr. Robert J. Haggerty's lead- 
ership the Child Health Division, 
founded by Dr. Harold Stuart, has 
become a very important focus for 
preventive and social pediatrics and 
for family medicine. The effective- 
ness of this division has been en- 
hanced by its new quarters — the re- 
modeled former Brace Shop across 
Blackfan Street from the Out-Patient 
entrance; this space provides adequate, 
conveniently arranged offices and a 
playroom, conference room above with 
good clinic space downstairs. In addi- 
tion, an outdoor play yard, which can 
be entered from the Unit as well as 
from the rear of the old houses along 
Longwood Avenue where the Mater- 



51 



DEPARTMENT OF MEDICINE 



nal and Infant Care program and the 
Children's Mission are situated, has 
been laid out and equipped with funds 
from the Daffodil Club. 

The Child Health Division pro- 
vides staff and quarters for Well Child 
Conferences sponsored by the Health 
Department of Boston, in which in- 
struction of medical students and 
house officers in preventive pediatrics 
is carried on. 

A major undertaking of the Child 
Health Division is the Family Health 
Care Program. This is a small or- 
ganized practice among 129 medically 
indigent families comprising 254 chil- 
dren and 258 parents living in the 
vicinity of the hospital. Health pro- 
tection services are provided free, 
while a small charge is made for of- 
fice and home visits for illness. Sta- 
tistics for the year were: 

Visits to Clinic 

for health supervision 876 

Visits to Clinic 

or home for acute illness 538 

Visits for chronic illness 122 

Other visits (follow-up, etc.) 383 



Total Patient Visits 1919 

These families are cared for by the 
staff under two programs: (1) A 
house officer program, in which pedia- 
tric residents in training assume re- 
sponsibility throughout their period 
of appointment for the provision of 
complete pediatric care to the chil- 
dren in several families, usually in- 
cluding one with a child with chronic 
illness; (2) a medical student pro- 
gram, given as an elective course in 
Family Medicine in which third year 
students assume the complete medical 
care of all the members of one or two 
families for a year. This latter pro- 
gram requires teaching from the De- 
partments of Obstetrics, Medicine, and 
Psychiatry of the Medical School and 
from the Boston Lying-in and Peter 



Bent Brigham Hospitals; parents as 
well as children are seen in the new 
quarters of the Child Health Division, 
a great advantage in unifying this 
program. The Family Health Care 
Program was developed primarily for 
educational purposes, to provide an 
opportunity for the future pediatri- 
cian to learn the skills of family prac- 
tice as part of his total pediatric 
training and for students to learn more 
about the role and function of the 
physician in his traditional task of 
providing medical service to families. 
It has also become a rich source of 
research material in social medicine 
and in the epidemiology of accidents 
and respiratory infections, and should 
provide an opportunity to experiment 
with ways to make the work of the 
family pediatrician more effective and 
more satisfying in the future. 

This educational pilot study has 
been assisted by a large grant to the 
Harvard Medical School from the 
Commonwealth Fund in support of 
the teaching of comprehensive pedia- 
tric medicine. This grant, which has 
also assisted the Adolescent Unit and 
the Department of Psychiatry, will be 
finished at the end of the coming year. 
Exact evaluation of such a program is 
difficult. We are convinced that such 
a family practice is an important ad- 
junct to the wards and clinics of the 
hospital in the development of a well- 
rounded program of clinical teaching 
and research in pediatrics. 

The major need of the Child 
Health Division for the coming period 
is financial support to permit con- 
tinuity in the further development of 
the teaching and research programs 
which have been well established. 

Adolescent Unit 

Like the Child Health Division, the 
Adolescent Unit has played an impor- 
tant role in broadening the concept 



of pediatric medicine and has ex- 
tended the responsibilities of The 
Children's Hospital Medical Center 
beyond its walls, through participation 
of its staff in school health programs, 
language disability studies in schools, 
and even into a summer camp pro- 
gram for obese adolescent girls. In 
reporting on the year Dr. J. Roswell 
Gallagher writes: 

'As the Adolescent Unit ap- 
proaches its tenth year of operation, 
its staff and its services and physi- 
cian-training program seem to be 
sufficiently stabilized so in the next 
few years increasing attention can 
be given to the development of an 
appropriate research program, to 
the more satisfactory bed care of 
adolescents admitted to the Hospi- 
tal's medical service, to the develop- 
ment of a few specialty clinics for 
those adolescents whose care and 
study are better carried out by spe- 
cialists than in a generalist setting 
such as the Unit's, and to the acqui- 
sition of sufficient endowment or 
annual gift funds to provide for the 
cost of the Unit's operation. Each 
of these matters has been given con- 
siderable thought, but none has been 
as actively pursued in the past as 
should be the case in the near fu- 
ture. 

"The Unit's Out-Patient Service 
continues to grow and seems to be 
well regarded by its patients and by 
the physicians who refer patients to 
it. In order to preserve the atmos- 
phere which we believe best suited 
to both patient care and to the train- 
ing of physicians in the care of 
adolescents, it would seem likely 
that any further expansion of our 
staff or facilities or any significant 
increase in our patient load would 
be undesirable. At present it is our 
group's opinion that efforts should 
be directed toward maintaining and 



52 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



improving the quality of our serv- 
ice rather than toward increasing its 
size. Over the years the number of 
serious and unusual illnesses seen 
has increased considerably as has 
the variety of medical problems. 
This is no doubt due to a wider 
public understanding of our Unit's 
function and a lessening of the be- 
lief that our major concern was 
adolescents' behavioral disorders. 
This latter understanding is also re- 
flected in the decrease in the number 
of serious emotional disorders re- 
ferred to us: a situation which is 
clearly desirable from the standpoint 
of patients and hospital alike." 
The work of this Unit has been 
greatly assisted by a grant from the 
Grant Foundation, for Staff and for 
traineeships. 

Cardiology Division 

The growth of the activities of 
this division has been steady and in- 
creasingly impressive. The Cardiac 
Clinic, which now must meet three 
(and soon four) afternoons a week, 
has a waiting list of over three months. 
The Catheterization Laboratory, which 
carries out approximately 500 proce- 
dures per year (about 2 per working 
day) has a waiting list of six to twelve 
months. The Sharon Cardiovascular 
Unit is kept full with patients under- 
going hospital study and surgical treat- 
ment of cardiac anomalies, and no 
beds can be spared for needed meta- 
bolic studies. As methods of diagnosis 
and treatment improve, more and 
more patients with congenital heart 
disease survive and demand some de- 
gree of follow-up care and study, thus 
adding to the case load. 

Dr. Alexander S. Nadas and his col- 
leagues have built up one of the most 
active children's cardiac units in the 
world, and in consequence patients 
come from a wide area for help, and 



students from everywhere are seeking 
training here. The department is pro- 
ductive, both in terms of trained men 
for academic positions elsewhere and 
in terms of clinical research. However, 
its growth poses very real problems. 
Although its quarters seemed very 
spacious two or three years ago, they 
are now quite inadequate. There is 
need for a research clinic, research 
beds, more office space and more and 
better integrated laboratory space in 
the immediate future. Funds to sup- 
port the work of this Division are no 
problem, but the funds available can- 
not be utilized unless the space needs 
are met. 

With Dr. Abraham M. Rudolph's 
departure to assume his new duties in 
New York, the experimental labora- 
tory has been taken over by Dr. Robert 
Grier Monroe, who has just completed 
three years of research training in Dr. 
James L. Whittenberger's laboratory 
in the Harvard School of Public 
Health. 

Dr. Benedict F. Massell's program 
of research on rheumatic fever is car- 
ried on at the House of the Good 
Samaritan. Thanks to a grant from 
the National Heart Institute to provide 
basic support for his research program 
for a term of years, it is possible to 
plan and carry out long-term studies 
of the impact of the increasingly effec- 
tive modern measures for prevention 
and treatment upon the incidence and 
outcome of this important disease. 

Pulmonary Laboratory 

For the past few years Dr. Charles 
D. Cook has built up an increasingly 
productive and useful laboratory for 
the study of pulmonary physiology in 
children. Although severely handi- 
capped by lack of space, this labora- 
tory has carried out important col- 
laborative studies of pulmonary 
disturbances with other groups in the 



hospital — in cases of asthma, pan- 
creatic fibrosis, and scoliosis and in 
children under anesthesia. Its work is 
supported by a grant from the Na- 
tional Institutes of Health and funds 
donated by the Lloyd family. 

Allergy Division 

The Allergy Clinic is one of the larg- 
est in our Out-Patient Department 
and its staff, who are all part-time 
unpaid physicians, are giving the Hos- 
pital a great deal of excellent service. 
Since Dr. Harry L. Mueller became 
Allergist two years ago, he has inaugu- 
rated a research and training program 
in this field, but this is still seriously 
hampered by lack of funds and even 
more by lack of space. A prospective 
study of the development of allergic 
manifestations, starting in early in- 
fancy in children with a family his- 
tory of allergy, is being made with a 
grant from the Ross Laboratories. 

Neurology Division 

Dr. Randolph S. Byers, assisted by 
Dr. Richmond S. Paine, has continued 
to carry a tremendously heavy load of 
clinical work and consultation in this 
all-important area of pediatrics. 

The work of the Division has been 
greatly strengthened in the last few 
years by several developments: 

(1) Formalization of a training pro- 
gram in pediatric neurology, which 
has been able to utilize two oppor- 
tunities in the Harvard setting, a brief 
experience for each trainee with Dr. 
Derek Denny-Brown at the Boston 
City Hospital, and a basic course in 
neuro-sciences for neurological trainees 
organized by Dr. Paul Yakovlev; 

(2) The development of a splendid 
laboratory of Neuropathology in the 
Department of Pathology under Dr. 
Elizabeth Q. Banker; (3) Funds from 
the grant to The Children's Hospital 
Medical Center from the National 



53 



DEPARTMENT OF MEDICINE 



Foundation for Neuromuscular Dis- 
eases which have made these develop- 
ments possible. Dr. Byers and Dr. 
Banker are collaborating in a long- 
term combined clinical and pathologi- 
cal study of Neuromuscular Diseases 
in Children which should be a very 
important contribution. An excellent 
group of Fellows in Neurology work- 
ing with Dr. Byers and Dr. Lombroso 
have stimulated both teaching and 
clinical research in neurology. 

The Seizure Unit, under Dr. 
Cesare T. Lombroso, continues its ac- 
tive program of care, teaching, and 
research in the field of epilepsy. Con- 
siderable investigation of the use of 
the electroencephalograph for localiza- 
tion of brain lesions at operation is 
being carried on with the Department 
of Neurosurgery as well. 

The Maternal and Infant Care 
Program, under the direction of Dr. 
Richmond S. Paine, represents a new 
and important aspect of our neurologi- 
cal activities. It is responsible for 
long-term follow-up of selected infants 
observed by Dr. Stewart H. Clifford's 
group at the Boston Lying-in Hospi- 
tal through pregnancy, delivery, and 
part of the first year. Together, these 
two integrated programs constitute 
the largest single project in the col- 
laborative Study of Perinatal Factors 
in Brain Damage in Children being 
supported by the National Institute 
for Neurological Diseases and Blind- 
ness. 

Hematology Division 

Over the past twenty years Dr. Louis 
K. Diamond has gradually built up an 
exceedingly strong program of re- 
search and training in pediatric hema- 
tology. Beginning with simple 
hematologic studies in children with 
blood diseases, the group has grown 
and extended its work through the 



Blood Grouping Laboratory under Dr. 
Fred H. Allen, Jr., into the field of 
blood grouping, normal and abnormal 
blood group antibodies and the treat- 
ment of erythroblastosis fetalis. The 
use of exchange transfusion in this 
disease has not only reduced mortality 
but almost eliminated an important 
cause of the athetoid type of cerebral 
palsy. In recent years the interests of 
the Hematology Division have ex- 
tended into a study of aplastic anemia, 
with encouraging results from the use 
of certain steroid hormones in treat- 
ment. A clotting laboratory, headed by 
Dr. Campbell W. McMillan, is study- 
ing the metabolism and the physio- 
logic and therapeutic effects of human 
clotting proteins, prepared by Protein 
Foundation, in patients with hemo- 
philia and other hereditary disorders 
of coagulation. Under Dr. Park S. 
Gerald and Dr. Mary Efron, both of 
whom have recently returned from 
genetic and biochemical training in 
England, an excellent laboratory for 
the study of the chemical structure of 
abnormal hemoglobins and the rela- 
tion between genetics, chromosomal 
abnormalities, and the synthesis of 
certain blood proteins has been set up. 
In fact these laboratories provide an 
ideal nucleus for a center for the study 
of human genetics, one of the real 
frontiers of modern pediatrics. These 
investigations have been made possible 
by grants from the National Heart In- 
stitute and the John A. Hartford 
Foundation, Inc. 

Metabolic Diseases 

Metabolic problems remain a central 
concern of the full-time staff of the 
department and provide the focus for 
our training program for future pedia- 
tric investigators. The laboratories are 
scattered, but the group meets regu- 
larly for critical discussion of research 
in progress. 



( 1 ) Kidney diseases and mineral 
metabolism are the prime interests of 
Dr. Francis X. Fellers, who continues 
to use the chemical laboratories estab- 
lished by Dr. James L. Gamble. In 
addition to supervising the care and 
study of patients with nephrosis, with 
assistance from the New England Kid- 
ney Disease Foundation, Dr. Fellers is 
actively investigating the metabolism 
of Vitamin D and renal tubular dis- 
eases. 

(2) Laboratories for the study of 
protein metabolism under Dr. David 
Gitlin are temporarily located in 
beautiful new laboratory space loaned 
by the Children's Cancer Research 
Foundation. Here a group is inten- 
sively studying a number of features 
of the basic processes of protein 
synthesis with a constant effort to 
apply the knowledge and techniques 
developed in the laboratory to an 
understanding of human disease. Sup- 
port for these laboratories comes from 
the National Institute of Arthritis and 
Metabolic Diseases and from the 
American Heart Association. 

(3) Endocrine Laboratories were 
established a few years ago under Dr. 
John F. Crigler, Jr., in unused labora- 
tory space in the House of the Good 
Samaritan. After a few years these 
laboratories have been filled to capa- 
city. Dr. Norman I. Gold, a talented 
steroid biochemist, and Dr. Jerome A. 
Grunt, a teacher of anatomy now 
turned pediatrician, have joined the 
laboratory and supervise the training 
of an active group of fellows. With 
help from many sources, including the 
Ten-Aiders, the National Institutes of 
Health, the Medical Foundation, and 
some private gifts, these laboratories 
have been equipped and staffed, and 
the Endocrine group is now making a 
vital contribution to care, teaching 
and research in this Hospital. 



54 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



It is impossible to give more than 
a bird's-eye view of the activities of 
these various groups interested in one 
or another special field of pediatrics. 
Certain gaps in our coverage of medi- 
cal problems will be noted. Problems 
of the newborn are under particularly 
intensive study at the Boston Lying- 
in Hospital by Dr. Clement A. Smith's 
team. Nutritional diseases and pan- 
creatic fibrosis are cared for and 
studied by Dr. Harry Shwachman, with 
his research laboratories in the Divi- 
sion of Clinical Laboratories. Infec- 
tious diseases are under investigation 
by Dr. John F. Enders and his asso- 
ciates in the Division of Infectious 
Disease Research. There are a num- 
ber of other instances where impor- 
tant segments of pediatrics are being 
studied in other departments. This is 
all to the good. Pediatrics is the medi- 
cine, surgery and pathology of the 
human during the period of growth 
from conception through adolescence. 
It needs the interest, effort and 
thought of men from every discipline, 
if its many problems are to be solved 
to provide better health for the com- 
ing generation. 

NEEDS 

The needs of the Department of Medi- 
cine are, first of all, the needs of all 
the departments of the Hospital — 
adequate stipends for house officers 
and new endowment to support key 
members of the staff on a secure long- 
term basis in each department. One 
department should not grow strong at 
the expense of another. The Hospital, 
since its services to patients, it teach- 
ing, and its research depend upon 
interdepartmental cooperation, should 
be a "balanced ship" as far as possible. 
Two new ventures started in the 
last decade, which have been sup- 
ported by temporary grants in their 
infancy, now require more lasting sup- 



port — the Child Health Division and 
the Adolescent Unit. 

Perhaps the most critical need is 
for the construction of facilities for 
clinical research — offices, special clin- 
ics, laboratories, record room, and li- 
brary — in close proximity to the wards 
or out-patient clinics. Without these 
new facilities, in the near future, the 
momentum of the Hospital's develop- 
ment will be lost, the morale of the 
Staff will be impaired, and the funds 
which finance so much of our work 
will be harder to obtain. In prepara- 
tion for this, we are doing everything 
possible, assisted by the improved 
Hospital accounting system, to put the 
financial affairs of the department in 
order. But we believe that it is im- 
perative that we move ahead as 
rapidly as possible with the develop- 
ment of final plans for construction 
of the Clinical Research Building. 

Charles A. Janeway, M.D. 
Physician-in-Chiej 



Bibliography 

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tion. N. E. J. Med., 262:511, I960. 

Bucci, G., Cook, C. D., and Barrie, 
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Cook, C. D., Fetal and neonatal anoxia. 
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, Barrie, H, and Avery, M. E., 

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Cook, C. D., Barrie, H., DeForest, S. A., 
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physiology in children, III. Lung 
volumes, mechanics of respiration 
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scoliosis. Pediatrics, 23:766, I960. 

Cook, C. D., Barrie, H, Helliesen, P. 
J., and DeForest, S. A., Lung volumes 
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Cook, C. D., and Haggerty, R. J., 
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various lung volumes in normal 
children and adults. Fed. Proc, 19: 
377, 1960. 



55 



DEPARTMENT OF MEDICINE 



Cook, C. D., O'Brien, D., Hansen, J. 
D. L., Beem, M., and Smith, C. A., 
Water and electrolyte economy in 
newborn infants of diabetic mothers. 
Acta Paediat., 49:121, I960. 

Earle, D. P., Hutt, M. P., Schmid, K., 
and Gitlin, D., Observations on 
double albumin: a genetically trans- 
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Eley, R. C, Diphtheria. Method of R. 
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Fellers, F. X., Idiopathic hypercalcemia 
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Ferris, B. G., Jr., and Cook, C. D., 
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Nelson, W. E. (Ed.), Textbook of 
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Gitlin, D., Immunochemistry and its 
relationship to atherosclerosis. In 
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and Janeway, C. A., Turnover 

of the copper and protein moieties 
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1960. 

Gitlin, D., Janeway, C. A., Apt, L., and 
Craig, J. M., Agammaglobulinemia. 
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and Humoral Aspects of the Hyper- 
sensitive States. Hoeber, 1959. 

Gold, N. I., Intermediary metabolism 
of Cortisol. Symposium on metabo- 
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878, 1959. 

, Smith, L. L., and Moore, F. D., 

Cortisol metabolism in man: obser- 
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2238, 1959. 

Janeway, C. A., Agammaglobulinemia. 
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, Infection, immunity and al- 
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-, Infections with the coliform, 



proteus, and pseudomonas groups of 
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1959. 

James Lawder Gamble. 1883- 



1959. Harv. Med. Alumni Bull., 
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1959. Pediatric profiles. /. Pediat.. 
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-, Lymphocytic choriomeningitis. 



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-, The scholar and the devil's 



advocate. In Report of the First 
Institute on Clinical Teaching. /. 
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, The student, the patient, and 



the teacher as seen by Institute par- 
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Med. Educ, 34:101, 1959. 

et al. Designated discussion. 



In Mechanisms of Hypersensitivity, 
International symposium, Henry 
Ford Hospital, Detroit. Little Brown, 
1959. 

Kamat, V. B, Hoelzl Wallach, D. F., 
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The intracellular localization of 
hormonal activity in transplantable 
thyrotropin-secreting pituitary 
tumors in mice. /. Biophys. & 
Biochem. Cytol, 7:219, I960. 

Katz, R. A., Intravenous urea in the 
therapy of increased intracranial 
pressure with lead encephalopathy. 
N. E. J. Med., 262:870, I960. 

Kevy, S. V., Chief resident symposium. 
How they run their pediatric serv- 
ices. Res. Physic, 6:66, I960. 

Korn, D., Demonstration of cystine 
crystals in peripheral white blood 
cells in a patient with cystinosis. 



N. E. J. Med., 262:545, I960. 

Lathrop, D. B., Cystic disease of the 
liver and kidney. Pediatrics, 24:215, 
1959. 

Pendleton, M. E., Adrenal hemorrhage 
and retroperitoneal hematoma fol- 
lowing perinatal stress. /. Pediat., 
56:308, I960. 

Smith, C A., Circulatory factors in re- 
lation to idiopathic respiratory dis- 
tress (hyaline membrane disease) 
in the newborn. /. Pediat., .56:605, 
1960. 

, Neonatal pediatrics, Part III. 

Prevention of prenatal and neonatal 
deaths. Am. Pract. & Dig. of Treat- 
ment, 2:265, I960. 

-, Overuse of milk in the diets 



of infants and children. J.A.M.A.. 
172:567, I960. 

-,The newborn infant. J.A.M.A., 



272:433, I960. 

-, Physiology of the Newborn 



Infant, 3rd ed. Thomas, 1959- 
— , The professor, the student, 



and the newborn infant. Univ. Mich. 
Bull, 15:293, 1959. 

Snedeker, L. E., et al., Care of Children 
in Hospitals. American Academy of 
Pediatrics, I960. 

Sutherland, J. M., Oppe, T. E., Lucey, 
J. F., and Smith, C. A., Leg volume 
changes observed in hyaline mem- 
brane disease. Am. J. Dis. Child., 
98:24, 1959. 

Whittenberger, J. L., and Cook, C. D, 
Neonatal resuscitation. Merck, 
Sharpe & Dohme, Seminar Report, 
4:22, 1959. 

Adolescent Division: 

Gallagher, J. R., About people, not in- 
juries. Am. J. Surg., 98:332, 1959. 

, Adolescents: Their character- 
istics and care. Survey Paper. White 
House Conference on Children and 
Youth, I960. 

-, General principles in clinical 



care of adolescent patients. Pediat. 



56 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Clin, of N. Am., 7:185, I960. 

-, Medical Care of the Adoles- 



cent. Appleton-Century-Crofts, I960. 
-, Meeting the needs of the hos- 



pitalized adolescent. In Care of 
Children in Hospitals. American 
Academy of Pediatrics, I960. 
, Problems of adolescents in 



school and residential settings. 
Workshop on Emotional Problems 
of the Indian Students in Boarding 
Schools and Related Public Schools. 
Albuquerque, N. Mex., April I960. 
-, Specific language disability 



(dyslexia). Clin. Proc. of Child. 
Hosp. (Washington, D.C.), 16:1, 
1960. 

and Harris, H. I., Psychiatry: 



behavioral problems in the adoles- 
cent. Ann. Rev. of Med., 11:275, 
I960. 
and Locke, W. N., Foreword. 



In Hermann, K., Reading Disability. 

Thomas, I960. 
Heald, F. P., Obesity in the adolescent. 

Pediat. Clin. ofN. Am., 7:207, I960. 
and Sturgis, S. H., Adolescent 

gynecology: a 5 -year study. Pedi- 
atrics, 25:669, 1960. 
Masland, R. P., Jr., Ulcerative colitis. 

Pediat. Clin, of N. Am., 7: 197, I960. 
Peckos, P. S., Spargo, J. A., and Heald, 

F. P., Program and results of a camp 

for obese adolescent girls. P. G. 

Med., 27:527, I960. 
Williams, M., A clinic for adolescents: 

a survey of 750 patients. Med. J. 

of Australia, Aug. 15, 1959, 201. 

Allergy Division: 

Hill, L. W, and Mueller, H. (Eds.), 

Pediatric allergy. Symposium. Ped. 

Clin. N. Am., 6: No. 3, 1959- 

Cardiology Division: 

Nadas, A. S., Approach to diagnosis of 
congenital heart disease without re- 
course to special tests. Circulation, 
20:602, 1959. 

and Hauck, A. J., Pediatric as- 



pects of congestive heart failure. 
Circulation, 21 : 424, I960. 

Reynolds, J. L., Nadas, A. S., Rudolph, 
A. M., and Gross, R. E., Critical 
congenital aortic stenosis with mini- 
mal electrocardiographic changes. A 
report on two siblings. N. E. J. Med., 
262:276, I960. 

Rudolph, A. M., Kurland, M. D., Auld, 
P. A. M., and Paul, M. H. (with the 
technical assistance of Sara R. Dun- 
can and Mary E. Stone), Effects of 
vasodilator drugs on normal and 
serotonin-constricted pulmonary ves- 
sels of the dog. Am. J. Physiol., 
197:617, 1959. 

and Auld, P. A. M., Physical 

factors affecting normal and 
serotonin-constricted pulmonary ves- 
sels. Am. J. Physiol., 198:864, I960. 

Rudolph, A. M., Auld, P. A. M., and 
Golinko, R. J., Effects of changes 
of systemic and pulmonary arterial 
and venous pressures on bronchial 
collateral flow. Fed. Proc, 79:March, 
1960. 

, Factors affecting bronchial 

collateral flow in the dog. Am. J. 
Physiol., 198:1166, I960. 

Sasahara, A., Rudolph, A. M., Hoff- 
man, J. I. E., and Hauck, A. J., Ven- 
tricular fibrillation during catheter- 
ization of the right side of the heart 
terminated successfully by external 
defibrillation. N. E. J. Med., 261: 
261, 1959. 

Young, E., Liebman, J., and Nadas, 
A. S., The normal vectorcardiogram 
of children. Am. J. Cardiology, 5: 
457, 1960. 

Child Health Division: 

Cook, C. D., Barrie, H., Helliesen, P., 
Mycetismus (amanita phalloides). 

Haggerty, R. J., Deaths from perma- 
nent antifreeze ingestion. N. E. J. 
Med., 261:1296, 1959. 

, Methyl alcohol poisoning. 

N. E. J. Med., 262:367, 1960. 

and Ziai, M., Acute bacterial 



meningitis in children. A controlled 
study of antimicrobial therapy, with 
particular reference to combinations 
of antibiotics. Pediatrics, 25:742, 
I960. 

Lowe, B., Acute mercury poisoning. 
N. E.J.Med., 261:409, 1959- 

Rosen, F. S., Parathion. N. E. J. Med., 
262:1243, I960. 

Salber, E. J., Rejection of breast feed- 
ing. Med. Times, 88:430, I960. 

Stuart, H. C, Evaluation of growth 
data. 7. Pediat., 55:803, 1959. 

, The search for knowledge of 

the child and the significance of his 
growth and development — examples 
from the Harvard Longitudinal 
Studies. Borden Award Address. 
Pediatrics, 24:701, 1959. 

et al., Longitudinal studies of 



child health and development, Series 
II. Supplement to Pediatrics, 24: 
875, 1959. 

Hematology Division: 

Allen, F. H., Jr., Case records of the 
Mass. Gen. Hosp., case 45391. N. E. 
J.Med., 261:658,1959. 

, Erythroblastosis fetalis. Lec- 
ture notes for third year medical 
students. Harvard Med. School Dept. 
of Obstet. & Gynecol., 1959. 

-, Minimizing transfusion risks. 



Mass. Physic, 28:273, I960. 

-, Rational blood replacement 



in the surgical patient. Conn. Med.. 
24:364, I960. 
, Review of the new blood 



group factors. Quart. Rev. Pediat., 
15:13, I960. 
, Corcoran, P. A., and Ellis, 



F. R., Some new observations on 
the MN system. Vox Sanguinis, 5: 
224, I960. 

-, and Diamond, L. K., Erythro- 



blastosis fetalis: attempts at preven- 
tion by desensitization (abstract). 
Am. J. Dis. Child., 98:503, 1959. 
-, von Bercken, T., and Boyce, 



S. J., Crossmatching of blood for 



57 



DEPARTMENT OF MEDICINE 



massive transfusion. Bull. Am. 
Assoc. Blood Banks, 12:267, 1959. 
-, Corcoran, P. A., Allen, F. H., 



Jr., Allison, A. C, and Blumberg, 
B. S., Blood groups of Alaskan Eski- 
mos and Indians. Am. J. Phys. An- 
throp., 17:187, 1959. 
, Sickles, G. R., and Allen, F. H., 



Jr., Anti-C (Anti-rh) identified by 
absorption technic. Bull. Am. Assoc. 
Blood Banks, 13:234, I960. 

Jones, A. R., and Kaneb, L., A new 
property of iso-agglutinins of the 
ABO blood group system. Blood, 
14:1094, 1959. 

, Some properties of cross re- 
acting antibody of the ABO blood 
group system. Blood, 1.5:395, I960. 

Jones, A. R., Kaneb, L., and Abra- 
hamov, A., A technique for the 
titration of "cross-reacting antibody" 
in group O serum. /. Lab. & Clin. 
Med., 54:11% 1959. 

Shahidi, N. T., and Diamond, L. K., 
Enzyme deficiency in erythrocytes in 
congenital nonspherocytic hemolytic 
anemia. Pediatrics, 24:245, 1959. 

, Skull changes in infants with 

chronic iron-deficiency anemia. N. 
E.J.Med., 262: 137, I960. 

, Testosterone-induced remis- 



sion in aplastic anemia. Am. J. Dis. 
Child., 98:293, 1959. 

Good Samaritan Division: 
Bland, E. F., Declining severity of rheu- 
matic fever: a comparative study 
of the past four decades. N. E. J. 
Med., 262:597, I960. 

Neurology Division: 

Burnstine, R. C, and Paine, R. S., 

Residual encephalopathy following 

roseola infantum. Am. J. Dis. Child., 

98:144, 1959. 
Crothers, B., and Paine, R. S., The 

Natural History of Cerebral Palsy. 

Harvard, 1959. 
Lennox, W. C, with collaboration of 

M. A. Lennox, Epilepsy and Related 



Disorders. Little, Brown, I960. 

Lombroso, C. T., and Forsythe, I., A 
long-term follow-up of acetazola- 
mide (Diamox) 1 in the treatment 
of epilepsy. Epilepsia, 1:493, I960. 

Paine, R. S., Evaluation of familial bio- 
chemical determined mental retard- 
ation in children, with special refer- 
ence to aminoaciduria. N. E. J. Med., 
262:658, I960. 

Papers published by members of 
the Department of Medicine on 
work carried out in the division 
of Laboratories and Research: 
Crocker, A. C, and Landing, B. H., 
Phosphatase studies in Gaucher 's 
disease. Symposium on hereditary 
metabolic diseases. Metabolism, 9: 
341, 1960. 
Evans, A. E., Roentgen therapy of cer- 
tain complications of acute leuke- 
mia in childhood. M. J. Roentgenol., 
82:541, 1959. 
Ghadimi, H., and Shwachman, H., De- 
tection of aminoaciduria in retarded 
children by a simple, rapid method. 
In Bowman, P. W., and Mautner, 
H. V. (Eds.), Mental Retardation: 
Proceedings of First International 
Medical Conference. Grune & Strat- 
ton, I960. 
, A screening test for amino- 
aciduria. N. E. J. Med., 261:998, 
1959. 

-, Evaluation of aminoaciduria 



in infancy and childhood. Am. J. 
Dis. Child., 99:451, I960. 

Ghadimi, H., Stern, M., and Shwach- 
man, H., A study of the free amino 
acids in sweat from patients with 
cystic fibrosis. Am. J. Dis. Child., 
99:333, I960. 

Green, M. N., Rickstniece, E., Valdes- 
Diaz, O., and Shwachman, H., Elim- 
ination of background staining in 
the periodic acid-Schiff method for 
protein-bound carbohydrates in 
paper electrophoresis. /. Lab. & 



Clin. Med., 55:158, I960. 

Enders, J. F., Katz, S. L., and Medearis, 
D. N., Jr., Recent advances in 
knowledge of the measles virus. In 
Rutgers University Institute of 
Microbiology, Perspectives in Virol- 
ogy. Wiley, 1959. 

Katz, S. L., and Enders, J. F., Immuni- 
zation of children with a live at- 
tenuated measles virus. Am. J. Dis. 
Child., 98:605, 1959. 

Kibrick, S., Role of coxsackie and 
ECHO viruses in human disease. 
Med. Clin, of N. Am., 43:1291, 
1959. 

Reich, P., Shwachman, H., and Craig, 
J. M., Lycopenemia. A variant of 
carotenemia. N. E. J. Med., 262: 
263, I960. 

Shwachman, H., Clinical pathological 
conference. /. Pediat., 56:551, I960. 

, Cystic fibrosis. In Collier's 

Encyclopedia. Collier, I960. 

-, Nutrition of children with 



congenital metabolic disorders. Fed. 
Proc, 18:22, 1959. 

Therapy of cystic fibrosis of 



the pancreas. Pediatrics, 25:155, 
I960. 

-, Fekete, E., Kulczycki, L. L., 



and Foley, G. E., Effect of long- 
term antibiotic therapy in patients 
with cystic fibrosis of the pancreas. 
In Antibiotics Annual, 1958-1959. 



59 



DEPARTMENT OF SURGERY 



REPORT OF 
SURGEON-IN-CHIEF 



In I960 the general Surgical Service 
of The Children's Hospital Medical 
Center has had the busiest year in its 
history. A study of statistics over the 
past three decades shows that during 
the latter half of the thirties and 
through the war years, our operative- 
load ran rather consistently between 
1,300 and 1,400 per year. Following 
the war there was a crescendo in ac- 
tivities, indicated by a progressive 
increase in the number of operations 
up to about 1,700 in 1945 and 1946. 
Since that time, there has been an ir- 
regular load, but a general advance. 
In the current year, as the table below 
shows, a total of 2,732 operations was 
performed, about twice the number of 
fifteen years ago. 

OPERATIONS ON 

GENERAL SURGICAL SERVICE 

October 1, 1959 to September 30, I960 

Abdominal surgery 526 

Hernias 434 

Thoracic surgery 519 

Genito-urinary surgery 388 

Head and Neck conditions 163 

Plastic surgery 189 

Excision of Surface lesions 101 
Extremity surgery 81 

Diagnostic procedures 177 

Miscellaneous 154 



Total operations 



2732 



A review of the current patients 
on our Service shows that there is a 
widespread use of surgical therapy in 
handling abdominal conditions, intra- 
thoracic anomalies, cardiac malforma- 
tions, urological conditions, to men- 
tion but a few. Babies and children 
are not immune to problems requiring 
surgical treatment, and indeed our ex- 
perience indicates that a large number 
of children in the early years enter 
life-and-death struggles for which 
surgical management must be avail- 



able. While one of the miracles of 
human life is the constancy in forma- 
tion of the intricate mechanisms and 
systems of the living body, the fact 
remains that at times these complex 
developments do go awry. Thus par- 
ents are presented with a baby with a 
serious abnormality of intestine, lung, 
heart, kidney, bladder or other organs. 
One might believe that such mal- 
formations are rare, yet we find that 
1,818 operations were performed here 
last year for the correction of various 
deformities. (This figure does not in- 
clude statistics from our other surgical 
services — the neurosurgical, ortho- 
pedic, or otolaryngological — which 
handle anomalies in their respective 
fields.) 

As one studies in detail the kinds 
of cases which have been brought to 
our attention during the last two and 
one-half decades, it is immediately 
evident that there is an outstanding 
difference between a surgical service 
such as ours and that of a general 
surgical service in a standard com- 
munity hospital. In the latter one finds 
rather uniformly the same types of 
cases, year after year, but in increasing 
numbers in recent years. Conversely, 
in a children's hospital there always 
have been definite peaks in types of 
patients. It is characteristic to have a 
concentration in certain types of cases 
for a period, followed in subsequent 
years by a fall-off in case-load of this 
particular problem. Developments 
which originate at our Center have a 
tendency to attract the kind of patient 
for which this given technique is help- 
ful. However, as such a surgical pro- 
cedure becomes refined and can be 
made routine, this kind of surgery is 
gradually taken up in outlying hospi- 
tals; hence, there is a corresponding 
fall-off in this kind of illness coming 
into our Center. 

Thus, the increase in total num- 



60 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



ber of operative cases per year (indi- 
cated above) is not merely a continual 
build-up of the same forms of opera- 
tions which we had fifteen or twenty 
years ago. Instead, there have been 
successively a number of conditions 
which have been attacked here, be- 
cause we could show the way to con- 
quer in new territories. Newer tech- 
niques have constantly brought an 
ever wider variety of cases. Indeed, 
this is as it should be, for a Center 
such as ours should be constantly on 
the march. Our largest job is to pro- 
vide initiative and a newer, better 
way of doing things. After we can 
perfect a technique, such learning 
should be passed on and employed as 
routine care in other hospitals in the 
state and throughout the country. 

An objective view of our posi- 
tion in surgery in the United States 
makes it evident that our Surgical 
Service is not going to progress in size 
in the future, or even maintain its 
present level, if we merely rest on our 
laurels and continue to practice sur- 
gery as we know it today. For a con- 
tinuing growth there must be an in- 
vestigative spirit if we are to develop 
and offer to the public new and im- 
proved devices and methods of han- 
dling some of the baffling problems 
which children are always presenting 
to us. The Surgical Service feels em- 
phatically that its future depends 
largely on what we can develop from 
the Animal Laboratory for Surgical 
Research, and from our analytical ef- 
forts at the level of clinical investiga- 
tion. We must continually have new 
tricks, because only if we can pull a 
new rabbit out of the hat from time 
to time, can we hope to have a chil- 
dren's surgical section which is vigor- 
ous and growing. 

To sum up the activities of a 
surgical department might sound like 
a cold review of statistics and a dis- 



play of operative techniques which 
give us some justifiable pride, but we 
must never lose sight of the fact that 
we are dealing with human lives, at- 
tractive children, and valuable mem- 
bers of society. It is important to 
emphasize that high technical skill 
and modern scientific management of 
surgical disease must always be accom- 
panied by understanding, by warmth, 
and by a friendly spirit, a realization 
that the youngster has feelings, emo- 
tions, and distress. Among his many 
problems, physical and psychic, there 
is often uppermost in a child's con- 
sciousness a sense of profound loss or 
abandonment, engendered by the tem- 
porary separation from his home en- 
vironment. In an institution which 
grows like ours, there could be some 
fear that augmentation in size is un- 
avoidably accompanied by relaxation 
in personal attention to patients and 
their families. Fortunately, I think 
the entire staff of The Children's 
Medical Center is constantly aware 
that while we have illnesses to treat, 
we also have children to handle and 
keep as happy as possible. In my files 
are literally hundreds and hundreds of 
letters, voluntarily and spontaneously 
written by parents, expressing thanks 
for the manner in which the staff doc- 
tors, the residents and interns, and the 
nurses have cared for their loved ones. 
No surgical service can progress 
very far without a closely integrated 
Out-Patient Department. Through 
these portals come a high percentage 
of patients who eventually enter the 
house for major surgical work. It is 
therefore highly important that our 
Out-Patient Department be of a na- 
ture which will constantly attract new 
subjects. Further, almost all surgical 
cases require some measure of post- 
operative care and supervision, which 
are performed in the Out-Patient clin- 
ics or offices. These services should be 



carried out for youngsters and their 
families in as quiet an atmosphere as 
possible, and in a place which is as 
attractive as we can make it. Good 
postoperative handling of patients and 
the writing of an accurate, prompt re- 
port to referring physicians have much 
to do with the building up in the 
minds of parents and outside doctors 
the thought that our services are com- 
petent, kindly, and efficient. These im- 
pressions determine to a considerable 
extent the number of patients which 
will be referred to us in the future. 
Hence, it is highly important for us to 
strengthen the Out-Patient Depart- 
ment, and make it a first-class part of 
our plant and activity. I am pleased to 
report that the Trustees have agreed 
to a refurbishing and redecorating of 
the Surgical Wing of the Out-Patient 
Department, which will begin very soon. 

During the greater part of 1959, the 
Laboratory for Surgical Research had 
to shut down its routine activities com- 
pletely, because of the extensive mod- 
ernization and equipping of the unit, 
with the adding of a new floor above 
for animal quarters. Towards the end 
of that year investigative endeavors 
gradually resumed, and during I960 
they have been in full swing, and are 
intense and productive. We have been 
fortunate in having Dr. Samuel R. 
Schuster spend a large part of his time 
in the Laboratory, and are very happy 
to have Dr. William F. Bernhard with 
us as a full-time leader in research en- 
deavors. Under these men, there have 
been four Research Fellows, two Re- 
search Assistants, and during the sum- 
mer several medical students. 

A number of projects are currently 
under study, including: 1. The use and 
control of profound hypothermia, to 
facilitiate operations on the heart and 
brain, and also to help in removal of 
some large tumors which otherwise 
are thought to be inoperable. 2. A 



61 



DEPARTMENT OF SURGERY 



study of blood circulation outside of 
the body in small subjects under 15 
pounds. 3. A study of various pros- 
theses and appliances, for replacement 
of damaged heart valves. 4. A study 
of the prevention of adhesions within 
the abdominal cavity, a complication 
which has long baffled clinical surgeons, 
particularly those interested in surgery 
of early life. 5. The setting up and 
production of various artificial shunts 
within the heart or regional blood ves- 
sels, to simulate some of the congeni- 
tal cardiovascular shunts in children, 
thus giving us a basis for the study of 
the disturbed states made by these leak- 
ages. 6. A review and testing of vari- 
ous plastic materials, which might be 
helpful in the construction of an arti- 
ficial abdominal wall, looking forward 
to the possibility of better treatment 
for babies who have large omphalo- 
celes (hernias of the navel). 

I feel that we can be quite proud 
of the Laboratory for Surgical Research. 
It is now housed in excellent modern 
quarters, has a high-grade staff, and 
allows us to push forward on many 
lines of investigation which will bring 
us new or improved techniques for 
handling many of the distressing con- 
genital anomalies which constantly 
come to our hospital door for help. 
The Laboratory budget runs something 
over $100,000 per year. Funds to 
underwrite this have been generously 
made available to us through grants 
from the United States Public Health 
Service, the American Heart Associa- 
tion, the Godfrey M. Hyams Trust, 
and literally hundreds of individual 
donors interested in seeing this work 
progress as rapidly as possible. 

Listed below are recent publica- 
tions from various members of the 
general Surgical Staff. 

Robert E. Gross, M.D. 
Surgeon-in-Chiej 



Bibliography 

Bernhard, W. F., and Gross, R. E., 
Extracorporeal circulation and pro- 
found hypothermia. A new surgical 
technique. Proc. N. E. Cardiovasc. 
Soc. (In press.) 

Bernhard, W. F., Schwarz, H. F., and 
Gross, R. E., Metabolic alterations 
associated with profound hypo- 
thermia and extracorporeal circula- 
tion in the dog and man. ( In press. ) 

Bernhard, W. F., Schwarz, H. F., Leand 
P. M., and Carr, J. G., Studies in 
balanced hypothermic perfusion. 
Surg., Gynec, & Obst. (In press.) 

Bernhard, W. F., Schwarz, H. F., and 
Mallick, N. P., Elective hypothermic 
cardiac arrest in normothermic ani- 
mals. Ann. Surg. (In press.) 

, Intermittent cold coronary 

perfusion as an adjunct to open 
heart surgery. Surg., Gynec, Obst., 
7/1:744, I960. 

-, Profound hypothermia as an 



adjunct to cardiovascular surgery. 
/. Thoracic Surg. (In press.) 

Gross, R. E., Farber, S., and Martin, 
L. W., Neuroblastoma sympatheti- 
cum. A study and report of 217 
cases. Pediatrics, 23:1179, 1959. 

Gross, R. F., Sauvage, L. R., Pontius, 
R. G., and Watkins, E., Jr., Experi- 
mental and clinical studies of a 
siphon-filling disc-oxygenator sys- 
tem for complete cardiopulmonary 
by-pass. Ann. Surg., 1.52:285, I960. 

Gross, R. F., Schwarz, H. F., Mallick, 
N. P., and Bernhard, W. R, Herzstill- 
stand durch kalte coronarperfusion 
in normal warmen tier. Swiss J. 
Med. (In press.) 

Gross, R. F., and Woolley, M. M., 
Esophageal atresia and tracheoeso- 
phageal fistula. (In press.) 

Hoffman, J. I. E., Rudolph, A. M., 
Nadas, A. S., and Gross, R. E., 
Pulmonic stenosis, ventricular septal 
defect, and right ventricular pressure 
above systemic level. Circulation, 



XXU-A05, 1960. 

Holder, T. M., and Gross, R. E., 
Temporary gastrostomy in pediatric 
surgery. Experience with 187 cases. 
Pediatrics, 26:36, I960. 

Longino, L. A., and Holder, T. M., 
Rectal bleeding in infants and chil- 
dren. Ped. Clin. N. Am., 6:1153, 
1959. 

Longino, L. A., Woolley, N. M., and 
Gross, R. E., Esophageal replace- 
ment in infants and children with 
use of a segment of colon. J. A.M. A., 
171:1187, 1959. 

Mansfield, P. B., An apparatus for elec- 
tive fibrillatory cardiac arrest in 
experimental and clinical cardio- 
pulmonary by -pass surgery. /. 
Thoracic & Cardiovasc. Surg. (In 
press.) 

Nadas, A. S., Rudolph, A. M., and 
Gross, R. E., Pulmonary arterial 
hypertension in congenital heart 
disease. Circulation, XXII: 1041, 
1960. 

Redo, S. F., Nadas, A. S., and Gross, 
R. E., Atresia of the mitral valve. 
(In press.) 

Replogle, R. L, and Gross, R. E., Renal 
circulatory response to cardiopul- 
monary by-pass. In Surg. Forum 
46th Clin. Cong., American College 
of Surgeons, I960. 

Reynolds, J. L., Nadas, A. S., Rudolph, 
A. M., and Gross, R. E., Critical 
congenital aortic stenosis with mini- 
mal electrocardiographic changes. A 
report on two siblings. N. E. J. 
Med., 262:276, I960. 

Richardson, W. R., and Watkins, E., 
Blood volume studies in pediatric 
surgical patients. In Surg. Forum 
46th Clin. Cong., American College 
of Surgeons, I960. 

Sasahara, A. A., Nadas, A S., Rudolph, 
A. M., Wittenborg, M. H., and 
Gross, R. E., Ventricular septal de- 
fect with patent ductus arteriosus. 
A clinical and hemodynamic study. 



62 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



REPORT OF 
ANESTHESIOLOGIST 



Circulation, XX7I:254, I960. 

Sauvage, L. R., and Gross, R. E., 
Observations of experimental grafts 
in the intrathoracic venae cavae. 
Surg., Gynec, Obst., 110:569, I960. 

Sauvage, L. R, Gross, R. E., Rudolph, 
A. M., Pontius, R. G, and Watkins, 
E., Jr., An experimental study of 
tissue and prosthetic grafts with 
selected application to clinical in- 
tracardiac surgery. Ann. Surg. (In 
press.) 

Sauvage, L. R., Pontius, R. G, Watkins, 
R, Jr., and Gross, R. E., Simple 
technique for implantation of ex- 
perimental grafts in the outflow 
tract of the right ventricle. A note 
on defibrillation of the hypothermic 
canine heart. Ann. Surg., 132:65, 
I960. 

Sauvage, L. R., Rudolph, A. M., and 
Gross, R. E., Experimental replace- 
ment of the aortic arch by homo- 
grafts. /. Thoracic & Cardiovasc. 
Surg., 40:61, I960. 

, Replacement of the main 

pulmonary artery bifurcation by 
autogenous pericardium. /. Thoracic 
& Cardiovasc. Surg., 40:56, I960. 

Schuster, S. R., Contribution to surgi- 
cal section of Gallagher, J. R., 
Medical Care of the Adolescent. 
Appleton-Century-Crofts, I960. 

, Diaphragmatic hernias in in- 
fants and children. Quart. Rev. 
Pediat, 15:171, I960. 

-, The recognition and manage- 



Wesolowski, S. A., Sauvage, L. R., 
Sawyer, P. N., Karlson, K. E., and 
Fox, L., The growth of cardiovascular 
chambers following cardiac and 
aortic surgery. /. Thoracic & Cardio- 
vasc. Surg., 40:692, I960. 



ment of diaphragmatic hernias in 
infancy and childhood. (In press.) 

Smith, E. I., and Gross, R. E., The ex- 
ternal anal sphincter in cases of 
imperforate anus. A pathological 
study. (In press.) 

Shwachman, E. E. H., and Hendren, 
W. H., Intestinal obstruction of the 
newborn infant. Usefulness of the 
sweat electrolyte test in differential 
diagnosis. N. E. J. Med., 264:13, 
1961. 



The year I960 was one of average ac- 
tivity for the Anesthesia Service. An- 
esthesia was administered for approx- 
imately 5,000 operations; this total 
included a sizeable number of ortho- 
pedic, neurosurgical, and cardiovascu- 
lar procedures. 

The most exacting problems con- 
tinue to be met in newborn infants 
undergoing correction of serious con- 
genital anomalies including intestinal 
atresias, omphalocele, diaphragmatic 
hernia and tracheo-esophageal fistula. 
Special attention was focussed on this 
phase of our work in the past year. 
Progress was made in techniques of 
administration, but more especially in 
methods of maintaining physiological 
stability of the infants. The use of 
specially constructed infant blood pres- 
sure apparatus and of continuous meas- 
urement of body temperature has been 
of considerable help. 

A major attempt has been made 
to prevent and control shock during 
extensive operations in infants and 
children, this being at present our 
greatest single problem in anesthesia. 

Considerable effort continues to be 
devoted to teaching. At present, resi- 
dents in anesthesia come to this Hos- 
pital on regular rotation from five 
other teaching hospitals (Peter Bent 
Brigham, Massachusetts General, Lahey 
Clinic, Massachusetts Memorial Hos- 
pitals, and University of Miami). 
These residents come for periods of 
three or four months. In addition, 
training is offered on a fellowship basis 
to physicians who have completed res- 
idency requirements, but who wish to 
devote six months or more to special 
training in pediatric anesthesia. 

Scientific investigations have been 
carried on chiefly at a clinical level. 
This year marked the introduction of 
a new general anesthetic agent, halo- 
thane, into our regular practice. Orig- 
inal investigation was carried out in 



63 



DEPARTMENT OF SURGERY 



the use of a narcotic, phenazocine, this 
work being reported at The World 
Congress of Anesthesiologists at Tor- 
onto. A study of postoperative pain 
was reported at the annual meeting of 
the American Society of Anesthesiolo- 
gists, and a study on shock reported 
before The International Anesthesia 
Research Society. 

Robert M. Smith, M.D. 
Anesthesiologist 



Bibliography 

Smith, R. M., Anesthesia for emer- 
gency surgery in children. Proc. 
Royal Soc. Med. (In press.) 

and Engineer, E. H., Problems 

related to open heart operations in 
children, Part I. Anes. & Anal, 
39:104, 1960. Part II, Anes. & 
Anal, 39:267, I960. 

Smith, R. M., Stetson, J. B., and 
Sanchez-Salazar, A., Postoperative 
distress in children. Anesthesiology. 
(In press.) 



65 



DEPARTMENT OF ORTHOPEDIC SURGERY 



REPORT OF ORTHOPEDIC 
SURGEON-IN-CHIEF 



THE YEAR 

The orthopedic service continued to 
be busy in its clinical divisions, in re- 
search, and in teaching. Compared 
with the previous twelve months, there 
were 2,000 more patient days of care 
on our orthopedic divisions in the year 
ending September 30, I960. The Res- 
pirator Unit, too, showed an 18 per 
cent increase in patient days. The aver- 
age daily census of orthopedic patients 
was fifty-eight, excluding orthopedic 
patients in the convalescent area of the 
House of the Good Samaritan. In the 
orthopedic out-patient divisions, there 
were 23,216 visits. This figure in- 
cluded the Growth Study, the Massa- 
chusetts Infantile Paralysis Clinic, and 
the outside treatment clinics for polio- 
myelitis. Considering only the general 
orthopedic out-patient clinic and the 
Massachusetts Infantile Paralysis Clinic, 
there was a drop of 8 per cent in at- 
tendance, largely due to the decreased 
number of visits to the Massachusetts 
Infantile Paralysis Clinic. The figures 
for the orthopedic division of the cere- 
bral palsy clinic are not included in 
these figures. This clinic showed an 
increase. 

TEACHING 

The major part of our teaching of 
undergraduate students of the Harvard 
Medical School affects the third year. 
The schedule was revised this year, the 
total hours of orthopedic instruction 
for each student being increased from 
33 to 45. These hours of instruction 
have been arranged so that continuity 
is better preserved and an increased 
proportion of the instruction is pro- 
vided to small groups facilitating stu- 
dent participation. Both students and 
instructors received the revision favor- 
ably. Trauma and orthopedic diseases 
of the skeletal and neuromuscular sys- 
tem are forming a larger and larger 
portion of medicine; expansion in in- 



struction in this area is greatly needed. 

RESIDENTS 

Our residents are the orthopedists of 
the future. They are the individuals 
upon whom the progress of orthopedic 
surgery depends. They will represent 
the Children's Hospital Medical Center 
everywhere. Our resident training pro- 
gram, if not the best, is as good as any. 

During the year there has been a 
revision in which the program has 
been expanded from three to three and 
a half years in length. Residents serve 
the first year at The Children's Hospi- 
tal Medical Center; the second year at 
The Massachusetts General Hospital. 
During the first half of the third year, 
all residents return to The Children's 
Hospital Medical Center; in the sec- 
ond half of the year, one-half the resi- 
dents return to The Massachusetts 
General Hospital, while the remaining 
half serve in the postgraduate program 
at The Children's Hospital Medical 
Center, the Peter Bent Brigham, and 
the West Roxbury Veterans Hospital. 
In this program eight new residents 
are appointed each year, two men re- 
porting every three months. The can- 
didates for appointment are required 
to have at least two years of training 
after medical school, including one 
year of surgery. The present staff is 
made up of eight residents in their first 
year of orthopedic training, five in 
their third year, and one in his fourth 
year. In addition, there are one or two 
residents assigned to the orthopedic 
laboratory and orthopedic pathology. 

Our residents are underpaid in 
relation to resident salaries generally 
and by all other judgments. For exam- 
ple, our assistant resident, who is in 
his first year of orthopedic surgery but 
in his third year of training, receives 
no salary at all. The residents then go 
to the Massachusetts General for their 
second year where they receive a mod- 



66 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



est stipend, returning to us in their 
third year to have a great reduction in 
income. It is a difficult situation. Solv- 
ing the problem of resident salaries 
must be a top priority of the hospital. 

RESEARCH 

Growth and factors influencing growth 
continue to be a major interest in the 
department. Originally this started as 
a study of the effects of poliomyelitis 
upon growth of the lower extremities 
but its scope has enlarged tremend- 
ously. It is concerned with the causes 
of abnormalities of growth, with the 
prediction of growth, and the develop- 
ment of methods of correcting dis- 
crepancies in growth. From this has 
come prediction charts that are used 
everywhere and techniques which are 
generally used in the correction of 
discrepancies in length of the extrem- 
ities. The enormous amount of longi- 
tudinal data which has been collected 
on the growth of the skeleton is a 
subject of active investigation. It is 
appropriate to pay tribute to Miss 
Margaret Anderson and Miss Marie 
Blais, research associates in this study, 
for their stimulating participation in 
this program. This work is largely 
supported by a research grant from the 
National Institutes of Health. Addi- 
tional funds come from Noemi, United 
Order of True Sisters. 

Dr. Jonathan Cohen's investiga- 
tions in the orthopedic laboratory have 
been largely concerned with biologic 
reactions to metals. This is a funda- 
mental study of the tolerance of the 
body to inert substances and the fac- 
tors involved in their use. The causes 
of failures of metals which have been 
implanted in the human body are a 
particular interest. Dr. Cohen and his 
work arc largely supported by a grant 
from the National Institutes of Health. 

Dr. Henry Banks and the Chief 
of the department have participated in 



a continuing investigation of the value 
of surgery in cerebral palsy. The con- 
tributions from this study have stim- 
ulated an increased interest in the use 
of surgery in spastic paralysis. This 
work has been supported in part by 
a grant from the United Cerebral Palsy 
Association. The U.C.P.A. also sup- 
ports an orthopedic fellowship in this 
area. In addition, Dr. Banks is study- 
ing the healing of fractures of the neck 
of the femur, supported in part by a 
grant from the National Institutes of 
Health. 

Dr. Trott is concerned with the 
development of artificial motors for 
use in the paralytic upper extremity 
and with the effect of continued heat 
on growth. The first of these received 
support from the National Foundation 
in relation to the Respirator Unit and 
the second is supported as an activity 
of the Public Health Service grant on 
growth. 

Different members of our staff 
have many other areas of investigation 
and clinical research in progress. Dr. 
Mihran Tachdjian has been develop- 
ing objective techniques for diagnostic 
evaluations in cerebral palsy; Dr. Paul 
Griffin is making a study of our ex- 
periences with bone tumors and their 
treatment — to mention two of the 
others. 

Members of our department have 
participated in numerous scientific 
meetings and have had many national 
responsibilities of various kinds. The 
magnitude of these demands can be 
conveyed by listing some of the activ- 
ities of the Chief of Service, excluding 
from this listing such things as ad- 
dresses before local societies and state 
meetings: 

Chairman, National Committee 
for the Study of Treatment of Cerebral 
Palsy 

Member of the Executive Com- 



mittee, American Academy of Ortho- 
paedic Surgeons 

Member of the Advisory Council 
for Orthopaedic Surgery, American 
College of Surgeons 

Member of the Executive Com- 
mittee, American Academy for Cere- 
bral Palsy 

Moderator of a Panel, "Pyogenic 
Infections of Bones and Joints," An- 
nual Meeting of American College of 
Surgeons 

Instructor in the Courses of In- 
struction for the American Academy 
of Orthopaedic Surgeons, along with 
Miss Anderson, on "Skeletal Age and 
the Control of Bone Growth" 

The "Honored Guest" of the 
Thirteenth Congress of the Brazilian 
Society of Orthopedics and Traumatol- 
ogy, reading two papers — "Bone 
Growth and Correction of Discrepan- 
cies in Leg Length" and "The Place of 
Surgery in the Treatment of Cerebral 
Palsy." 

In addition, the Head of the Serv- 
ice participated in a symposium on 
"Volkmann's Contracture" at the meet- 
ing of the Brazilian Surgical Society 
in Rio de Janeiro, and gave a series of 
lectures at the University of San Paulo 
in Brazil. 

This listing illustrates the type of 
responsibilities which the members of 
our staff carry in areas removed from 
the hospital. They require much time 
but they are necessary if one properly 
represents the Hospital and the Medi- 
cal School. 

Dr. Banks, a member of the Com- 
mittee for the Study of Treatment of 
Cerebral Palsy, gave an instructional 
course at the meeting of the American 
Academy for Cerebral Palsy on "Sur- 
gery of the Lower Extremities in Cere- 
bral Palsy." Dr. Cohen has been active 
as a member of the Executive Com- 
mittee and chairman of the Program 
Committee of the Orthopaedic Re- 



67 



DEPARTMENT OF ORTHOPEDIC SURGERY 



search Society, and was a participant 
in the Gordon Conference. 

STAFF 

Dr. Albert H. Brewster and Dr. 
Robert Morris, long senior members 
of our staff, were promoted to Ortho- 
pedic Surgeon, Emeritus, after many 
years of service to the Hospital. The 
Hospital is indebted to them. They 
gave much to it over the years and 
we miss their active participation. 

In July 1959 Dr. Paul Griffin, 
after an outstanding performance as 
Chief Resident, joined the staff as As- 
sistant Orthopedic Surgeon. Dr. Rob- 
ert Brownhill succeeded him as Chief 
Resident and also did an excellent job. 
Dr. Brownhill, after completing his 
residency in June of I960, joined the 
orthopedic staff of Baylor University 
in Houston, Texas. Dr. Charles F. 
Heinig in turn succeeded him. In 
January of I960, Dr. Mihran Tachd- 
jian was appointed to the staff as As- 
sistant in Orthopedic Surgery. Dr. 
Tachdjian, a graduate of the American 
University of Beirut, had his training 
in surgery and orthopedic surgery in 
the Chicago area in the Northwestern 
University program. He then became 
associated with Dr. Edward Compere, 
Professor of Orthopedic Surgery at 
Northwestern and in the Armed Serv- 
ices. He has had a brilliant record 
wherever he has been. We are pleased 
to welcome Dr. Griffin and Dr. Tachd- 
jian to our staff. 

Our staff has worked at full 
capacity throughout the year. In cer- 
tain areas it has been overextended in 
its responsibilities and would be more 
productive if it were not so busy. The 
only area that has suffered is research. 
Considering that our staff provides the 
teaching and clinical supervision of 
orthopedic surgery at the Peter Bent 
Brigham and the West Roxbury Vet- 
erans Hospital, it becomes apparent 



that it has much to do. A busy staff is 
a healthy staff but fewer clinical de- 
mands would lead to greater produc- 
tivity. Plans are underway for its ex- 
pansion. 

More and more in the changing 
pattern of medicine, an endowed chair 
in a department such as ours becomes 
essential if it is to carry out its work 
in the best possible way and contribute 
most to the field. Under the present 
arrangement, the Chief is primarily 
responsible for support of the depart- 
ment, although the Hospital has been 
of great assistance. Income from the 
practice of orthopedics is the primary 
source of support. It seems essential 
to the future that an endowed profes- 
sorship at Harvard Medical School be 
established in this hospital with pro- 
vision also being made for the support 
of other positions in the department 
so that greater stability and depth of 
staff can be established. 

POLIOMYELITIS 

One of the major changes affecting our 
department has been the decreasing 
number of cases of poliomyelitis. The 
annual incidence has been much re- 
duced since the severe epidemic of 
1955, in which there were more cases 
of poliomyelitis in Massachusetts than 
in any previous year. It is the natural 
epidemiologic characteristic of the dis- 
ease to have few cases for several years 
after a big epidemic such as we had 
in 1955 but a major factor in the 
lower incidence is the use of the Salk 
vaccine. This vaccine has not given 
an absolutely dependable immunity 
from the paralytic disease but it cer- 
tainly has had a major inhibiting ef- 
fect. One may expect poliomyelitis to 
show a decreasing trend so that it is 
no longer a serious threat. This ex- 
pectation must be a part of our plan. 

The treatment of the acute dis- 
ease and convalescence were not prob- 



lems in the past year but the patients 
who have had the disease in prior 
years still remain a major concern. 
They require medical care, they re- 
quire surgery, and general measures of 
rehabilitation. They will require help 
for many years. A child who has any 
significant degree of paralysis needs 
supervision until he is grown and 
some care is indicated after that. Pro- 
viding for the care of these individu- 
als has suddenly become more difficult 
in that there has been a major change 
in the financial aid which is available 
for patients with poliomyelitis. 

As a background, it seems appro- 
priate to review the relation of this 
hospital to the treatment of polio- 
myelitis over the years. This hospital, 
in fact, has had a distinguished his- 
tory in this field. Many of those who 
have contributed most to knowledge 
regarding this disease and its treat- 
ment have been members of this staff 
over the years, beginning with Dr. 
Robert W. Lovett, the Chief of Ortho- 
pedic Surgery from 1912 to 1922. 

In 1916 Dr. Lovett was largely 
instrumental in forming the Harvard 
Infantile Paralysis Commission, or- 
ganized at the time a large epidemic 
created a panic of fear and apprehen- 
sion in Massachusetts and in New 
York. The Commission was formed 
for the care and investigation of an- 
terior poliomyelitis. Its original clinic 
was located at Children's and this 
clinic has been maintained continu- 
ously since that time. The director of 
the clinic has always been a member 
of the orthopedic staff here at the 
Children's Hospital. As a part of this 
program, in addition to the central 
clinic, there have been regular treat- 
ment clinics held in various outlying 
cities and towns over the years, all 
conducted by the Children's staff. 

In 1946 Harvard Medical School, 
as a part of a move in which it 



68 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



severed all direct relations with the 
care of the patients, asked that the 
auspices of the Harvard Infantile 
Paralysis Clinics be transferred to the 
Hospital if this was possible. Ac- 
cordingly, in that year the clinics be- 
came the Massachusetts Infantile 
Paralysis Clinics of the Children's 
Hospital. Under this title the Clinics 
have continued to thrive under the 
same organization and plan over the 
years. Outside treatment clinics are 
still held in Beverly, Dedham, Haver- 
hill, Lawrence, Lowell, Maiden, Med- 
ford, Quincy, Somerville, and Wal- 
tham. The organizational plan was one 
which has been copied widely since it 
provided a continuity of care in 
chronic disease and made maximal use 
of skilled personnel in caring for such 
a disease. There have been only three 
directors of the clinics since 1916 — 
Dr. Lovett, Dr. Arthur Legg, and Dr. 
William T. Green. 

In addition to many contributions 
in the total field of poliomyelitis, the 
Clinics have a particular relation to 
education in poliomyelitis and prob- 
lems created by epidemics over the 
country. In collaboration with the Na- 
tional Foundation, Children's Hospital 
maintained for many years a Poliomye- 
litis Emergency Unit. This unit was 
called to many areas during devastat- 
ing outbreaks to give temporary help 
and organize local groups in the care 
of the disease. On one occasion dur- 
ing the second World War the unit 
was sent to Germany when an 
epidemic arose affecting the Armed 
Services in that area. For many years 
two postgraduate courses a year, of a 
week's duration, were given for physi- 
cians, instructing them in the treat- 
ment of poliomyelitis. These courses, 
along with annual courses for nurses 
and for physical therapists, were fos- 
tered by the National Foundation, 



which provided appropriate scholar- 
ships. 

Originally the Harvard Infantile 
Paralysis Commission had an annual 
drive to support the Clinics. These 
were well received and supported. In 
1940 New England Chapters of the 
National Foundation asked the Har- 
vard Infantile Paralysis Clinics to de- 
sist from raising funds to support the 
Clinics since, they said, it interfered 
with their fund raising; they indicated 
that they would support the Clinics. 
Accordingly, after many conferences, 
an agreement evolved in which the 
Chapters of the National Foundation 
agreed to support the Clinic, based on 
its annual budget in relation to the 
number of patients treated during the 
year. The per capita cost was deter- 
mined and each Chapter agreed to 
support the cost of care of the patients 
from their county. This was adopted 
in 1940 but it was not until 1944 that 
it became a reality. This was done on 
an annual basis and worked out as an 
efficient and pleasant arrangement 
over a 15 -year period, both to the 
Chapters and to the Clinic. 

Last year, however, the Chapters 
had increasing difficulty in meeting 
their payments. By July 1, 1959, they 
indicated that they were no longer in 
a position to pay for braces or other 
apparatus except under unusual cir- 
cumstances. In January they indicated 
that they were no longer able to main- 
tain their former financial support of 
the Clinics. Prior to this, as far back 
as 1916, no charge had been made to 
the patient for clinic service. During 
this time it had been self-supporting 
except for the space provided by the 
Children's Hospital. Any remodeling 
of the area had been provided by 
Clinic funds. 

It was necessary, therefore, on 
April 1, I960, to institute charges for 
visits and for physical therapy in the 



Clinic. For many patients of the 
Clinic this has been a difficult change, 
particularly if they have had expensive 
apparatus to purchase and maintain. 
In addition to the problems of patients 
who are unable to pay, there has been 
considerable reaction to the new situa- 
tion by other patients and their fami- 
lies, inasmuch as they had been accus- 
tomed to receiving this service without 
charge. 

This changed relation of the Na- 
tional Foundation to the support of 
poliomyelitis has also cast its shadow 
upon the patients who need hospital 
admission for surgery and other care. 
No longer does the Foundation freely 
underwrite the costs. In fact, a con- 
siderable amount is still due the hos- 
pital and the clinics for medical care 
during 1958-59. This changed relation 
in the National Foundation has arisen 
in part from the fact that the Founda- 
tion has broadened its base of interest 
and extended it to include other dis- 
eases. More than this, however, is the 
fact that it did not have sufficient 
funds in I960 to meet its obligations. 
In the meantime, the problems of the 
patients who have had poliomyelitis 
and need care and rehabilitation re- 
main with us. 

It is well to say, however, that 
the National Foundation does still aid 
the Respirator Unit to the extent of 
an annual grant of $54,434. For this 
we are most grateful. Even here, how- 
ever, the problems of hospitalization 
arise in that formerly the Chapters of 
the National Foundation gave addi- 
tional support for the care of patients 
from their Chapter by paying a per 
diem charge. This is no longer avail- 
able in most instances. 

THE COST OF CARE 

The changing pattern of support in 
poliomyelitis stimulates other com- 
ments regarding the cost of patient 



69 



DEPARTMENT OF ORTHOPEDIC SURGERY 



care. Hospitalizations for the treat- 
ment of the crippled child are likely 
to be longer than for many other types 
of illness. The increasing cost of medi- 
cal care and the decreasing proportion 
of these costs that are met by income 
from endowed funds compound this 
issue. The increased numbers of pa- 
tients whose hospitalization is covered 
by plans of voluntary insurance has 
been a big factor in meeting a part of 
this problem. Even where coverage 
exists, however, it is likely to be only 
partial in its extent. Support from 
additional sources is needed. 

One program that has been of 
great assistance over the years in pro- 
viding help to the crippled child and 
to the hospital in its care for such a 
child has been the Massachusetts 
Crippled Children's Services. Many of 
the members of our orthopedic staff 
are consultants for this program and, 
as consultants, hold monthly clinics 
for the Commonwealth in various 
parts of the State. In turn, the ma- 
jority of the patients from these par- 
ticular clinics are admitted here at the 
hospital for their surgery or for other 
care. The Crippled Child's program 
underwrites the cost of care and the 
hospital, in turn, helps the State pro- 
vide for effective, efficient medical 
care at a minimal cost provided all 
factors are considered. The patients 
are treated in the environment of a 
teaching program, which not only pro- 
vides the best of care to the patient 
but also provides for the values of ob- 
servation and education of the student 
and resident as well. 

The Crippled Children's Service 
supports the cost of hospitalization of 
these patients but does not pay medi- 
cal fees for surgery or for medical 
care. It does provide a fee for the 
actual conduct of monthly outside 
clinics. This is an arrangement which 
we hope will continue to be fostered 



by the Commonwealth and by the 
Hospital. The Crippled Children's 
Services are under the Commissioner 
of Health and the immediate direc- 
tion of Dr. Janice Rafuse. Our Serv- 
ice is privileged to participate in this 
program. 

Such support aids the hospital 
immeasurably in providing a strong 
program for the handicapped child 
which, in turn, is available to all our 
citizens whether they are in the State 
program or not. If this care comes to 
be provided more and more by state 
institutions, it will greatly weaken the 
care of the crippled child not falling 
under the aegis of a state program. I 
believe it is most important that the 
present arrangement be preserved and, 
indeed, expanded. Certainly the plan 
existing in certain states and counties 
to assist voluntary hospitals in pro- 
viding care through governmental aid 
has much to be said for it. 

We are convinced that, one way 
or another, increasing assistance will 
arise. New programs are arising. 
Whatever the source, we must be pre- 
pared to provide the service which 
merits support. 

Basically, if the hospital had in- 
creased endowment, many of our prob- 
lems would be solved. It is proposed 
that deficits arise because our percen- 
tage of occupancy is not high enough. 
In fact, one of the factors reducing our 
occupancy, as far as the crippled child 
is concerned, is the cost of care. If 
the hospital's endowment were suffi- 
cient to aid these patients in meeting 
their costs, the problems of occupancy 
and, indeed, the deficit would be an- 
swered together. Fundamentally, a 
hospital such as ours will always have 
a deficit if it is carrying out its duties 
to the full. It is only by increasing 
endowment income, special funds, and 
support by programs assisting in the 



cost of medicine that we can remain 
solvent. 

BUILDING 

The John Wells Farley Memorial 
Building has given us excellent fa- 
cilities for the care of the in-patient. 
In fact, if we were asked to recom- 
mend new accommodations for our 
orthopedic patients, we would be hard 
put to improve upon the present plan. 
The wards are well arranged. The 
children of various ages can be 
grouped as they should be. A plaster 
room on the division has proven to 
be a most effective arrangement. The 
close relation of the functional train- 
ing room and physical therapy, all 
combine to make this a very satisfac- 
tory unit. 

By contrast, our out-patient clinic 
leaves much to be desired. The pres- 
ent facilities are unattractive, crowded, 
and poorly arranged. They have little 
appeal to the patient and make work 
difficult. In the shifting pattern, am- 
bulatory services become a larger and 
larger part of medicine. Many of the 
conditions which were formerly 
treated in the hospital through long 
stays can now be treated in the clinic. 
The outpatient clinic, too, is the area 
where a hospital meets a large part of 
its public. It should be able to greet 
them well. This our hospital cannot 
do under the present circumstances. A 
new ambulatory clinic area is greatly 
needed. 

Another great need for space is 
in the area of research. It is quite es- 
sential to our department that our re- 
search activities be increased. Our de- 
partment has been the recipient of 
certain gifts of funds which give us a 
certain amount of hard-core support 
for increasing activity. We are striv- 
ing to increase this amount. With the 
increasing availability of support 
from research grants, our research ac- 



70 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



tivities can and should be expanded. 
Our laboratory areas are confined to 
the Growth Study area, on the sixth 
floor of the Bader building, and to a 
laboratory in the Jimmy Fund build- 
ing, available to us through the good 
offices of the Cancer Research Founda- 
tion and Dr. Farber. We do have a 
small laboratory, the Saltonstall Lab- 
oratory, on the second floor of the 
Farley Building. At the present time 
it is being used largely by the depart- 
ment of cardiology, which was in 
great need for space close to X-ray. 
Since we had the space in the Jimmy 
Fund Building, we were able to free 
a part of the second floor laboratory 
room temporarily for their use. 

Expansion of research is essential 
to the health of our department and 
with it more space is necessary. It is 
our conviction that a building housing 
ambulatory clinics and research labora- 
tories is a pressing need of the 
hospital. 

VOCATIONAL GUIDANCE 

As the Hospital increased the age of 
the children for which it is respon- 
sible, the need for vocational guidance 
of the handicapped child assumes 
greater and greater importance. If 
we provide maximal services for the 
handicapped child, it is important 
that he be directed into that vocation 
for which he is best suited. This 
means a combined assessment of his 
physical condition and the limitations 
imposed by his mental and emotional 
aptitudes. For example, in the patient 
with severe poliomyelitis, one can de- 
termine quite accurately what the par- 
ticular child will be able to do physi- 
cally when he is an adult. It is 
important to weigh all the factors 
which determine his potentialities. If 
this is done at a reasonably young age, 
one can guide his education, his inter- 
ests, and provide training in the field 



in which he can be most productive 
and most happy. 

Over the last two years our de- 
partment has fostered, with the Bay 
State Society, a guidance clinic which 
meets one day a week. The Bay State 
Society provided a very capable coun- 
selor, Mr. Richard LaPierre, and the 
clinic has been held in relation to the 
Massachusetts Infantile Paralysis 
Clinic area. This has been a pilot 
study, with most of the patients com- 
ing from the Infantile Paralysis Clinic, 
but it has indicated the values of such 
a service. An attempt has been made 
to get special funds to support this 
activity, but, so far, they have not be- 
come available. We need to expand 
our efforts in this area. There is a 
great need to supply better guidance 
to the growing handicapped child so 
that he may attain his maximal place 
in society. 

A list of publications from the 
department is appended.* 

William T. Green, M.D. 
Orthopedic Surgeon-in-Chief 



*We wish to thank all those who 
have made gifts to the department 
during the year, including the Ziskind 
Foundation, the Fuller Foundation, the 
Probonata Club, Dr. Howard K. Mor- 
rison, Mr. and Mrs. Eben Phillips, Mr. 
and Mrs. David Ross, with a special 
place for Noemi U.T.O.S. who year 
after year provide special support 
when it is needed. Finally, the Chief of 
Service wishes to express his appre- 
ciation for the loyal efforts of the 
Staff, the residents, the nurses, the 
physical therapists, the secretaries of 
the Department, and, indeed, for the 
support of the administration and 
trustees, and all others who have made 
this year what it has been. 



Bibliography 

Anderson, M., and Green, W. T., The 
femur and tibia: growth and pre- 
dictions of growth in later child- 
hood. (In preparation.) 

Banks, H. H, and Green, W. T., Cor- 
rection of equinus in cerebral palsy. 
In Yearbook of Orthopedics and 
Traumatic Surgery, 1959-60. 

, Adductor myotomy and ob- 
turator neurectomy for the correc- 
tion of adduction contracture of the 
hip in cerebral palsy. /. Bone Joint 
Surg., 42 A -All, I960. 

, Correction of hamstring con- 



tracture in cerebral palsy. (In prep- 
aration. ) 

Cohen, J., Simple bone cysts. /. Bone 
Joint Surg., 42/4:609, I960. 

and Foultz, W. S., Failure by 

corrosion of a Steinman pin. /. Bone 
Joint Surg., 42AA201, I960. 

Cohen, J., and Maletskos, C J., Ca 45 
in the study of bone grafts in dogs. 
Proceedings, Symposium of Inter- 
national Society of Traumatology 
and Orthopedic Surgery, I960. 

Cohen, J., and Sledge, C. B., Diastema- 
tomyelia. Am. J. Dis. Child., 100: 
257, 1960. 

Cohen, J., and Weinfeld, M. S., Ex- 
perimental excision of muscles in 
the weanling rat. /. Bone Joint 
Surg., 42A:278, I960. 

Green, W. T, and Anderson, M., 
Skeletal age and the control of bone 
growth. In Reynolds, F. E. (Ed.), 
Instructional Course Lectures, Amer- 
ican Academy of Orthopaedic Sur- 
geons, 17:199. Mosby, I960. 

Green, W. T., and Banks, H. H, Cor- 
rection of adduction-flexion, internal 
rotation of the hip in cerebal palsy. 
/. Bone Joint Surg., December 1959. 

Hilding, D. A., and Tachdjian, M. O., 
Dysphagia and hypertrophic spur- 
ring of the cervical spine. N. E. J. 
Med., 263:11, I960. 

Marshall, J. H, White, V. K, and 



Cohen, J., Autoradiography of serial 
cross sections of undecalcified bone. 
Rod. Res., 10:197, 1959. 
Quigley, T. B., and Banks, H. H., 
Medical progress, treatment of frac- 
tures and dislocations, 1950-1960. 
N. E. J. Med., 263:344, I960. 263: 
391, 1960. 263:444, I960. 263: 
493, 1960. 



71 



DEPARTMENT OF ORTHOPEDIC SURGERY 



73 



DEPARTMENT OF NEUROSURGERY 



REPORT OF 
NEUROSURGEON-IN-CHIEF 

Since its organization as a separate 
unit in the early 1930s, the Neuro- 
surgical Service has grown steadily. 
Like other departments of the Chil- 
dren's Hospital Medical Center, it 
serves a two-fold function; namely, as 
a community hospital (in the greater 
Boston area) ministering to children 
with head injuries, infections, congeni- 
tal anomalies and neoplasms and, sec- 
ondly, as a referral and consultation 
service for specialized and complicated 
problems of pediatric neurosurgery 
from all over the world. 

The influence of the Service has 
spread widely as a result of publica- 
tion, in 1954, of the first textbook 
devoted to pediatric neurosurgery. 
This text, Neurosurgery in Infancy and 
Childhood, by Franc D. Ingraham and 
Donald D. Matson, is now out of 
print; its revision is one of the tasks 
which must be fitted in the program 
of the next few years. The influence 
of the Neurosurgical Service also has 
been extended by men who have re- 
ceived special training in childhood 
neurosurgery here, and gone on to 
practice and teach in other centers in 
the United States and Canada. 

As a center for surgery and for 
training young men in this special 
field, the Neurosurgical Service of the 
Children's Hospital Medical Center is 
closely affiliated with that of the Peter 
Bent Brigham Hospital. Its four-year 
training program is approved by the 
Council on Medical Education and 
Hospitals of the American Medical 
Association and the American Board 
of Neurological Surgery. In addition 
to the staff men with regular appoint- 
ments in the clinics or laboratories 
service, the Hospital receives a steady 
stream of visitors from neurosurgical 
centers throughout the world inter- 
ested in the organization and function 
of this unit. 

In addition to taking part in the 



combined rounds and clinical patho- 
logical conferences of the whole Hos- 
pital, the Neurosurgical Service holds 
the following teaching conferences: 
monthly neuroradiology, bimonthly 
microscopic neuropathology, bi- 
monthly brain-cutting, monthly elec- 
troencephalography, and monthly spe- 
cial conferences in neurology, lab- 
oratory investigation, or related fields. 

One of the principal interests of 
the Neurological Service for many 
years has been the study of the normal 
circulation of cerebro-spinal fluid and 
the clinical treatment of various forms 
of hydrocephalus. Diversion of spinal 
fluid from the sub-arachnoid spaces 
into the urinary tract by modern 
methods was devised and first used 
by this Service in 1948, and has since 
had wide-spread use throughout the 
world. The newer types of shunting 
operations also have been continually 
investigated and employed. 

This Service has defined a variety 
of congenital conditions involving the 
nervous system either primarily or 
secondarily, and has developed tech- 
niques for surgical treatment. In 
addition to the treatment of certain 
types of hydrocephalus, these include 
procedures for premature closure of 
the cranial sutures, congenital dermal 
sinus tracts, diastematomyelia, spina 
bifida and such congenital tumors as 
papillomas of the choroid plexus and 
craniopharyniomas. The value of 
ACTH and cortisone as supportive 
treatment during surgical management 
of these latter tumors was first stressed 
in a paper from this Service in 1952. 
Results in afflicted children have vastly 
improved as a result of the cooperative 
efforts of the Endocrine and Neuro- 
surgical Services. 

The recognition and prompt 
treatment of neurological complica- 
tions of congenital heart disease, par- 
ticularly brain abscess, have been a 



74 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



special interest of the Neurosurgical 
and Cardiology Services in recent 
years. Many of these complications, 
previously almost invariably fatal, have 
been managed successfully with a 
combination of neurologic and cardiac 
surgery and intensive antibiotic 
therapy. 

With construction of the new op- 
erating rooms, adequately shielded 
equipment made possible careful op- 
erating room electrocorticography in 
the study and treatment of children 
with various types of epilepsy. Surgi- 
cal results have been most gratifying 
in well-selected cases. 

Another recent interest of the 
Neurosurgical Service has been in 
cerebrovascular diseases, or "strokes," 
in childhood, a hitherto largely un- 
explored field. The possibility of sur- 
gical treatment of arterial occlusion, 
both of extracranial and intracranial 
vessels is being studied, particularly 
by Dr. John Shillito. This work is 
supported in part by a National Heart 
Institute grant, now in its second year. 

The clinical work of the Neuro- 
surgical Service, as well as the training 
of men in the resident staff, has been 
significantly improved by the ima- 
ginative, careful, and provocative help 
of Dr. Betty Banker and her associates 
in the Neuropathology Division of 
the Pathology Department; it is hoped 
that the work will continue to be ex- 
panded. 

THE FUTURE 

What of the Future? There are many 
standard neurosurgical clinical prob- 
lems, such as those dealing with 
trauma, certain of the congenital mal- 
formations, infection, and benign tu- 
mors, that the Service will continue to 
attack and manage with the most 
careful clinical judgment and surgical 
skill possible. There are many areas 
in the field of pediatric neurological 



surgery that remain to be developed. 
Certainly the treatment of the com- 
mon gliomas of the brain has shown 
little progress in the last thirty years. 
The search continues for means of 
establishing differential uptake of a 
toxic chemical or radioactive agent in 
tumor as compared with normal brain 
tissue of sufficient degree so that an 
infiltrative tumor might be destroyed 
without similar destruction of the 
host's cerebral tissue. The application 
of intermittent or continuous perfu- 
sion techniques to temporarily isolated 
cerebral circulation to achieve higher 
concentration of cytotoxic agents in 
the tumor may contribute to this goal. 
Complete cessation of circulation to 
the brain for periods long enough to 
carry out complicated surgical proce- 
dures on vascular malformations and 
vascular tumors would seem to be pos- 
sible in the not-too-distant future 
under conditions of safe, profound 
hypothermia. Newer and better meth- 
ods to treat obstruction to spinal fluid 
circulation must be devised. Neuro- 
surgical measures in the treatment of 
involuntary tremor, spasms, and con- 
vulsive seizures seem certain to im- 
prove with further refinement of elec- 
trophysiological and stereotoxic meth- 
ods. Understanding of neuro- 
endocrine mechanisms will un- 
doubtedly be improved by work in 
both the laboratory and in the clinic. 

OPERATIONS 

The following tabulations reflect the 
activities of the Neurosurgical Service 
in the past year: 

ADMISSIONS — 517 

Congenital Anomalies 193 

Infections 24 

Intracranial Tumors 50 

Spinal Tumors 6 

Trauma 126 

Miscellaneous 118 

Total TiT 



Private 
Staff 
Total 

opd visits — 1188 
Average number of 
patients per clinic 

DIAGNOSTIC PROCEDURES 
Pneumoencephalograms 
Ventriculograms 
Myelograms 
Arteriograms 
Burr Holes alone 
Burr Holes and 

Ventriculograms 
PEG and Arteriograms 
Total 

OPERATIONS — 458 
Laminectomies 

Spinal Tumors 

Discs: Lumbar 
Cervical 

Abscess 

Pain Control 

Total 

CRANIOTOMIES 
Brain Tumors 
Subdural Hematoma 

and Membranes 
Vascular Disease 
Abscess 
Pain Control 
Head Injuries 
Epilepsy 
Other 

Total 

OTHER 

Brain Biopsy 
Excision 

Porencephalic Cyst 
Posterior Fossa 

Decompression 
Posterior 

Lysis of Adhesions 
Posterior 

Excision of Cyst 



161 
356 
~517~ 



22.84 

53 
47 
14 
29 

17 


10 

170 



33 

17 
7 
1 

5 
2 


65 



75 



DEPARTMENT OF NEUROSURGERY 



Posterior 

Exploration of V-C shunt 1 

Evacuation Epidural 

Hematoma 1 

Repair, CSF Leak 4 

Exploration, only 1 

Total 18 

DERMOID CYSTS 

Intracranial 2 

Cranial 8 

Spinal 1 

Total if 

Cranioplasties 2 

Craniectomies 30 

Meningoceles 1 1 

Encephaloceles 

Skull Fractures 1 1 

Peripheral Nerve Suture 4 
Other Peripheral 

Nerve Surgery 5 

Total 63 

SHUNTS 

Ventriculo-cervical 

Ventriculo-ureteral 6 

Ventriculo-peritoneal 2 

Lumbar-ureteral 5 

Lumbar-peritoneal 
Insertion of CSF Valve 

(V-J shunt) 34 

Subdural-peritoneal 1 

Torkildsen Procedure 
Revision or removal 

of shunt 54 

Total T02 

MISCELLANEOUS 

Repair, pseudo-meningocele 2 
Repair, CSF Leak 
Carotid Artery Exploration 
Debridement and Partial 

Craniotomy, Osteo 
Excisio, hamangioma of scalp 
Excision, hairy nevus 
Carotid perfusion 
Secondary wound closure 
Removal, varix of scalp 
Excision, A-V malformation 



Radical excision tumor, eye 1 
Excision, tumor of forehead 1 
Repair, surgical skull defect 1 
Biopsy, dura and frontal sinus 1 
Skin graft, upper eyelid 1 

Total ~2\ 

STAFF ACTIVITIES 

Dr. Robert W. Schick, who became 
Chief Resident of the combined Chil- 
dren's Hospital Medical Center-Peter 
Bent Brigham Hospital Neurosurgical 
Service on July 1, 1959, left the Cen- 
ter on December 31, I960, to begin 
practice in New York City with staff 
appointments at St. Luke's and Belle- 
vue Hospitals and the Neurosurgical 
Department of Cornell Medical School. 
Dr. John T. Garner, who had been 
Assistant Resident in Neurological 
Surgery since September 1, 1959, 
moved up to Chief Resident on Janu- 
ary 1, 1961. 

On July 1, I960, a third resident, 
Dr. Francis X. Rockett, was added to 
the Neurosurgical Service. He is a 
graduate of Harvard Medical School, 
with previous training in surgery at 
Boston City Hospital and two years 
of service in the Navy. 

It is now planned that each ca- 
reer neurosurgical trainee will remain 
three years on the combined Chil- 
dren's Hospital Medical Center-Peter 
Bent Brigham Hospital Neurosurgical 
Service, serving successively as Junior, 
Senior and Chief Resident. During the 
first year the Resident's work will be 
primarily in immediate supervision of 
the large neurosurgical ward at The 
Children's Hospital Medical Center 
with help in coverage of procedures 
and clinics at the Peter Bent Brigham 
Hospital and participation in all the 
various teaching exercises and confer- 
ences. In the second year the Resident 
will advance in responsibilities in both 
hospitals and will cover the Peter Bent 
Brigham Hospital surgical house offi- 



cer rotating through the Neurosurgi- 
cal Service. 

On June 30, I960, Dr. James T. 
Robertson finished a year as Clinical 
Fellow in Neurosurgery and entered 
the Air Force. He is now Assistant 
Chief of Neurosurgery at Travis Air 
Force Base, California. During the 
year Dr. Robertson read papers at the 
American Academy of Neurology and 
the New England Neurosurgical So- 
ciety, and collaborated on reports pub- 
lished in the Journal of Neurosurgery 
and Pediatrics. 

Dr. Nurhan Avman, one of the 
Research Fellows during the past year, 
has returned to Ankara, Turkey, to 
head the Department of Neurosurgery 
at the University of Ankara. 

Dr. Matson has continued as Sec- 
retary of the American Board of 
Neurological Surgery. He was also a 
member of the ad hoc committee of 
the National Institute of Neurological 
Diseases and Blindness to consider 
policy regarding training grants in the 
field of neurosurgery and has subse- 
quently been appointed to the Ad- 
visory Committee of the National 
Institute of Neurological Diseases and 
Blindness for a four-year period. 



PAPERS PRESENTED AT 
NATIONAL SOCIETY MEETINGS 

American Academy of Neurology, 
Miami Beach, Fla. 

American Academy of Neurological 
Surgery, Pebble Beach, Cal. 

American College of Surgeons, Atlan- 
tic City, N. J. 

American Academy of Pediatrics, 
Chicago, 111. 

American Surgical Association, White 
Sulphur Springs, Va. 

American Neurological Association, 
Boston, Mass. 

Harvey Cushing Society, San Fran- 
cisco, Cal. 



76 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Protein Foundation, Cambridge, Mass. 
Scandinavian Neurosurgical Society, 
Lund, Sweden. 

Post-Graduate Teaching Programs 
participated in: 

New Orleans Graduate Medical As- 
sembly 

Mid-South Post-Graduate Assembly, 
Memphis 

Houston Neurological Society 

12th Annual Pediatric Institute for the 
General Practitioner, Portland, Me. 

Other Meetings Attended: 

Congress of Neurological Surgeons, 

Miami, Fla. 
Neurosurgical Society of America, 

Pebble Beach, Cal. 
Society of Neurological Surgeons, 

Seattle, Wash. 
American Pediatric Society, Swamp- 

scott, Mass. 



NEUROSURGICAL RESEARCH 
LABORATORY 

In this first full year since the renova- 
tion of the Neurosurgical Research 
Laboratory there has been a consider- 
able increase in activity, although 
much of the equipment had to be in- 
stalled and the interior work com- 
pleted in the early months. 

The work of the laboratory has 
centered on two main projects: a con- 
tinuing one on the physiology of cere- 
brospinal fluid and the other on hypo- 
thermia, physiology of the body under 
lowered body temperatures. In addi- 
tion, a project on the pressure in the 
cerebral circulation, based on a model 
of the blood vessels, was carried out. 

The use of urea in conjunction 
with hypothermia was extensively 
studied during the year. This work 
was carried out in dogs over a tem- 



perature range of 37°-24°C, and hy- 
pertonic urea solutions were given to 
the cooled animals. Studies were made 
of the elimination of urea from the 
body, the mixing of urea with the cere- 
brospinal fluid, the exchange of osmotic 
equilibrium between the blood cere- 
brospinal fluid, the urinary output, and 
changes which occurred in the electro- 
lyte composition of the blood and the 
cerebrospinal fluid following the in- 
jection. It was demonstrated that the 
pressure changes effected by the urea 
depended upon the osmotic pressure 
gradient between the serum and cere- 
brospinal fluid, and this was independ- 
ent of any urinary output. The return 
of the serum osmotic pressure to nor- 
mal at normal temperatures was a 
function of the elimination of urea by 
kidneys, but when the body tempera- 
ture was lowered below 30°C, this 
return to normal was accomplished by 
the elimination of salt as well. This 
is an extremely important observatioa 
When this procedure is used in the 
clinic, great attention must be paid or 
serious conditions of low salt are likely 
to result. It was also determined that 
a smaller dose of urea was required to 
achieve the same effect at low body 
temperature. 

During the latter part of the 
year, attention was devoted to work 
on deep hypothermia and hypothermia 
combined with extracorporeal circula- 
tion. This work was designed to ex- 
plore temperatures below 20 °C and as 
yet has not produced enough data to 
warrant a report. 

Conclusive results in hypothermia 
also have been obtained in definite 
studies demonstrating that the metabo- 
lism of the brain is not a linear func- 
tion of temperature, and that oxygen 
is used by the brain at all tempera- 
tures. 

Studies on the cerebrospinal fluid 
were centered on the production of 



cerebrospinal fluid in the dehydrated 
state. This has long been known to be 
a condition in which intracranial pres- 
sure was decreased and cerebrospinal 
fluid was produced at decreased rates. 
It was felt that the study possibly 
would yield detailed information on 
the minimum quantities of cerebro- 
spinal fluid produced and the events 
associated with it. This work, carried 
out on dogs, demonstrated that in the 
dehydrated state the critical and con- 
trolling factor in the production of 
cerebrospinal fluid was the arterial 
blood pressure, and that there is a di- 
rect relationship between the arterial 
blood pressure and the cerebrospinal 
fluid production. This observation has 
suggested that there is a minimum 
amount of cerebrospinal fluid which 
will be produced by the hydrostatic 
forces of the cerebral blood flow, and 
it is this minimum which must be re- 
moved in order to prevent hydrocepha- 
lus from developing. It further demon- 
strated that there was no relationship 
between cerebral metabolism and cere- 
brospinal fluid production in the de- 
hydrated state, which is in contrast to 
the normal animal, whether it be 
hydrocephalic or not. 

Other experiments on the osmotic 
pressure of the cerebrospinal fluid 
show that the old concept of the total 
osmotic pressure of the cerebrospinal 
fluid being equal to that of the serum 
is probably wrong and that the cere- 
brospinal fluid is probably higher than 
the arterial blood by several mille- 
simals with the cerebral venous blood 
somewhere in between. This finding 
has been confirmed from studies on 
the intracranial pressure changes 
which seem to be a function of 
osmotic pressure. It has been found 
that the zero pressure change occurs 
when the cerebrospinal fluid is slightly 
above that of the blood. 

All these experiments, combined 



77 



DEPARTMENT OF NEUROSURGERY 



with those of the previous years, are 
being synthesized into a general de- 
scription of the cerebrospinal fluid 
formation which suggests that there 
are two important physical factors in- 
volved in the bulk and formation of 
cerebrospinal fluid: filtration by the 
blood and a movement of fluid second- 
ary to osmotic pressure changes. Super- 
imposed on these are the metabolic 
processes continually in action which 
function to keep the cerebrospinal 
fluid pressure composition constant. 

The other major project of the 
year was the construction of a model 
of the Circle of Willis and the arteries 
leading to it, using plastic tubing. The 
size and length of the various vessels 
were taken from the standard anatomi- 
cal texts, and a Sigmamotor pump was 
used to pump blood or fluid through 
the system. The peripheral vessels 
were given an added resistance so that 
the blood flow and pressure through 
the system was consistent with that of 
a normal adult. Various vessels were 
occluded and pressure measurements 
made beyond them and in the Circle 
of Willis to show the effects of these 
occlusions. Particularly important were 
the observations made on the vertebral 
arteries where very few have been 
made clinically. This work demon- 
strated that before occlusion of a verte- 
bral artery is carried out in the clinic, 
bilateral angiograms should be made 
in order to decide which vessel should 
be occluded. 

In another series of experiments 
in the realm of hypothermia it was 
shown that while occlusion of the total 
circulation of the brain can only be 
tolerated for 15 minutes, the middle 
cerebral artery could be occluded for 
as long as 45 minutes if the body 
temperature was at 25 °C. This find- 
ing is similar to results at normal 
temperature where the middle cerebral 
artery can be occluded for periods 



slightly longer than the total brain can 
withstand circulatory arrest. The rea- 
sons for this are not clear, but it was 
suggested that the small amount of 
circulation through the collaterals 
tends to remove metabolic products, 
possible C0 2 which allows a longer 
period of survival. 

Franc D. Ingraham, M.D. 
Neurosurgeon-in-Chief 



Bibliography- 
Bering, E. A., Jr., Cerebral spinal fluid 
production and its relationship to 
cerebral metabolism and cerebral 
blood flow. Am. J. Physiol., 197: 
825, 1959. 

, Preliminary studies of the 

temperature coefficient of blood 
clotting. Vox Sanguinis, 3: 82, I960. 
Crofton, F. D. L, and Matson, D. D., 
Roentgenological study of choroid 
plexus papillomas in childhood. Am. 
J. Roent., Rod. Therapy & Nuclear 
Med., 83:479, I960. 
Ingraham, F. D., and Bailey, O. T., 
Cystic teratomas and teratoid tumors 
of the central nervous system in in- 
fancy and childhood, Part II. / 
Neurosurg. (In press.) 

Ingraham, F. D., and Matson, D. D., 
Tumors of the central nervous sys- 
tem. In Cancer and Allied Diseases 
of Infancy and Childhood. Little 
Brown, I960. 

Jessiman, A. G., Matson, D. D., and 
Moore, F. D., Hypophysectomy in 
the treatment of breast cancer. N. 
E.J.Med. 261:1199, 1959. 

Matson, D. D., Comparison of bio- 
logical behavior of intracranial tu- 
mors of children and adults. Trans. 
Am. Neurol. Assoc, I960. (In 
press. ) 

, Congenital anomalies of the 

nervous system. In Davis, L. (Ed.), 
Christopher's Textbook of Surgery, 
7th ed. Saunders, I960. 

-, The management of acute 



compound battle-incurred injuries 
of the spinal cord. In Surgery in 
World War II, Neurosurgery, Vol. 
2. Office of the Surgeon General, 
Department of the Army, 1959. 
-, Surgical treatment of congen- 



ital anomalies of the coronal and 
metopic sutures. /. Neurosurg., 17: 
413, I960. 
and Crigler, J. F., Radical 



78 

REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



treatment of craniopharyngioma. 
Ann. Surg. (In press.) 

Matson, D. D., and Crofton, F. D. L., 
Papilloma of the choroid plexus in 
childhood. J.Neurosurg. (In press.) 

Matson, D. D., and Robertson, J. T., 
Therapeutic agents for reduction of 
intracranial pressure. Pediatrics, 25 : 
73, I960. 

Robertson, J. T., Schick, R. W., Mor- 
gan, R, and Matson, D. D., Ac- 
curate placement of ventriculo-atrial 
shunt for hydrocephalus under elec- 
trocardiographic control. /. Neuro- 
surg. (In press.) 

Selenkow, H. A., Tyler, H. R., Matson, 
D. D., and Nelson, D. H., Hypo- 
pituitarism due to hypothalamic 
sarciodosis. Am. ]. Med. Sci., 238: 
456, 1959. 

Shillito, J., Jr., Indications for surgery 
in cerebrovascular accidents. P. G. 
Med. (In press.) 

Uzman, L. L., Bering, E. A., Jr., and 
Morris, C. E., Neuraminic acid con- 
tent of cerebrospinal fluid as af- 
fected by neurological diseases. /. 
Clin. Invest., 38:1756, 1959. 



79 



DEPARTMENT OF PSYCHIATRY 



REPORT OF 
PSYCHIATRIST-IN-CHIEF 



INTRODUCTION 

Although this report was limited orig- 
inally to review of the structure, func- 
tions, and needs of the Child Psychia- 
try Department of The Children's 
Hospital, it soon became apparent that 
such an approach would give a rather 
circumscribed and narrow view of the 
treatment, training, and research ac- 
tivities relative to child mental health 
that are established and expanding in 
the Medical Center as a whole. The 
coordination of these activities in the 
Department proper with the allied or 
parallel activities going on in (a) the 
affiliated Judge Baker Guidance Cen- 
ter, plus the teaching programs in 
association with (b) the Harvard 
Medical School Department of Psy- 
chiatry (Child Psychiatry Division); 
(c) the Harvard University Depart- 
ment of Social Relations; and, (d) the 
Graduate School of Education, seemed 
to indicate that only a general sum- 
mary would be informative and inter- 
esting to the Trustees and others con- 
cerned about the mental health of 
children. 

Therefore, although the intent to 
give to the Trustees a definitive report 
of the mental health activities in prog- 
ress in the smaller unit (the Depart- 
ment of Psychiatry of the Hospital) 
is retained, we have attempted to pre- 
sent an overview of integrated and 
coordinated professional structures and 
functions. Depending on the context, 
we shall refer at times to (a) the 
Hospital "Department of Psychiatry" 
or (b) the "Judge Baker-Children's 
Hospital" Division, the latter referring 
in the main to our joint activities in 
association with various Schools and 
Departments of Harvard University. 

DEPARTMENTAL STRUCTURE AND 
BASIC SERVICE FUNCTIONS 

The professional personnel of the De- 
partment include three disciplines 



traditionally involved in child psychia- 
tric clinic treatment in America: child 
psychiatrists, clinical psychologists, 
and psychiatric social workers. 

In this report-year (July 1959 
through June I960), we have had a 
total of fifteen staff psychiatrists work- 
ing in the Department, but it is impor- 
tant to note that not one of them is 
full-time; seven are half-time ap- 
pointees, and the remaining eight 
work only four to sixteen hours per 
week. The inability to appoint psy- 
chiatrists to full-time status is, of 
course, due to the fact that we lack 
the financial resources.* These physi- 
cians value highly their hospital and 
clinic association because of the oppor- 
tunities to teach and to do research, 
but it is necessary for them to make 
their livelihood in private practice. 

There are eight clinical psycholo- 
gists in the Psychiatry Department, 
seven on full time. There also are 
eight staff psychiatric social workers, 
six on full time, one is on half time, 
and one on quarter time. 

The basic structure for the pro- 
fessional functions of the Department 
consists of the Central Psychiatry 
Clinic, assigned personnel to the Medi- 
cal Out-Patient and specialty clinics, 
assigned personnel on call in the vari- 
ous in-patient wards of the Hospital, 
personnel assigned to the Good 
Samaritan, the Children's Mission, the 
Children's Cancer Research Founda- 
tion, the Center for Blind Babies, the 
Well Child and Family Care Programs 
of the Department of Medicine, and 
the Adolescent Unit. 

The Central Psychiatry unit of 
the Department is housed on the third 
floor of Building A, and the renovated 



* The expenditures for salaries of Psychia- 
trists and for those in the other disciplines 
within the Department, together with a state- 
ment of the source of these monies, are given 
in Appendix B of this report. 



80 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



building at 328 Longwood Avenue. It 
has two important functions. In the 
first place, it has for its personnel 
people highly trained in child psychia- 
try, psychiatric social work, and clini- 
cal psychology who can carry out in- 
tensive long-term treatment of chil- 
dren referred from the various clinics 
and wards through the Hospital. It 
also is the nucleus of the whole De- 
partment in that various psychiatric 
"teams" are assigned from it to work 
within the other clinics throughout the 
Hospital. A notable example is the 
assignment of psychiatrists, social 
workers, and clinical psychologists to 
the Adolescent Unit. These teams 
carry out treatment within these clin- 
ics and aid in the training and teaching 
of personnel. 

From the Central Clinic research 
teams are organized to carry out re- 
search projects in the Department or 
in conjunction with personnel in other 
Departments of the HospitaL 

In short, the Central Clinic is the 
Department of Psychiatry's main base 
of operation, and its personnel have 
overall supervision of its own treat- 
ment, training and research functions 
and such functions carried out by as- 
signment to other services. 

The personnel assigned to the 
Medical Out-Patient Division of the 
Hospital are housed on the second 
floor of Building A, across the stair- 
well from the Medical Out-Patient De- 
partment, a convenient situation in the 
joint activities of the psychiatrists and 
psychologists with the pediatrician, 
pediatric residents, and medical stu- 
dents. 

To each of the in-patient wards 
and to the seven other areas listed 
above are assigned psychiatrists and 
psychologists who take part in psy- 
chiatric consultations and psychologi- 
cal evaluations of patients at the re- 
quest of the staff or resident physicians 



in these several areas. The personnel 
of some of these medical and surgical 
areas call upon us frequently for serv- 
ices, some infrequently and some not 
at all. Nonetheless, psychiatric teams 
are assigned specific areas of coverage 
throughout the Children's Hospital 
Medical Center and respond to all re- 
quests received. 

A statistical summary of the 
hours and sessions spent and the in- 
dividual patients seen in (a) intensive 
psychiatric treatment; (b) diagnostic 
and (c) consultation services for 
1959-60 appears in the table below. 

In reviewing these figures it is 
well to bear in mind that much more 
clinic time of various personnel is re- 
quired in mental health appraisals or 
diagnoses (and certainly in psychiatric 
treatment! ) than usually is the case in 
other medical or surgical specialties. 
In the mental health field both the 



child and the mother (plus usually the 
father in more recent years) must be 
seen separately, in interview sessions 
lasting one hour. Even a diagnostic 
work-up takes a good many more 
hours than one per patient. All these 
needed hours and careful evaluation 
cost society (and hospitals) a great 
deal of money, but in the light of our 
present body of knowledge and our 
present accepted clinical procedures, 
mental health work with children must 
be carried out this way, and particu- 
larly so in a hospital that is world 
renowned for its diagnostic, treatment, 
training and research facilities. 

Education, training, and research 

The education, training, and research 
functions of the Department must be 
viewed in the light of the integrated 
efforts of the Hospital Department of 
Psychiatry and the Judge Baker Guid- 



SERVICE STATISTICS 

July 1, 1959 -June 30, I960 

Therapy sessions with patients 3,814 
Interviews with parents of 

patients 3,332 

PSYCHOLOGICAL EVALUATIONS: 
(separate visits by patients, not hours) 
MOPD 

patients 61 6 

Wards 

patients 278 

Adolescent Unit 

patients 200 

House of Good Samaritan 

patients 3 

Seizure Unit 

patients 2 

Out-Patients (on a private fee level) 

patients 109 

Psychiatry Clinic 

patients 37 

Private In-Patients 

patients 48 



DIAGNOSTIC CONSULTATIONS: 

MOPD 

patients 585 

parents 563 

Adolescent Unit 

patients 34 

parents 1 5 

Seizure Unit 

patients 20 

parents 15 

Ward 

patients 131 

House of Good Samaritan 

patients 9 

Endocrine 

patients 25 

Total patients referred to the 
Psychiatry Department for 
evaluations 1,917 

Average number of children seen 
in therapy during current year 202 

Average case load in intensive 

treatment at any one time 140 



81 



DEPARTMENT OF PSYCHIATRY 



ance Center. In their integrated seg- 
ments they, in turn, relate to the ac- 
tivities of the Department of Psychia- 
try of the Harvard Medical School 
since in combination the two units are 
now considered a Division of this 
medical school faculty group. 

The Judge Baker Guidance Cen- 
ter is the second oldest child psychiatry 
clinic in America and, due to the sci- 
entific work and writings of its first 
Director, Dr. William Healy, has at- 
tained a gratifying national and inter- 
national reputation during its nearly 
half century of work. However, the 
Center, like most traditional child 
guidance units, was established and 
had developed somewhat outside the 
main stream of medicine (and, in- 
deed, of general adult psychiatry) . A 
decade or more ago it became apparent 
to leaders in the field of child psychia- 



try that this separation from medicine, 
particularly from pediatrics, was not 
promoting mental health of children 
either through psychiatry or through 
pediatric care. The trustees and the 
staff of the Judge Baker were among 
the first to recognize the need for a 
rapprochement between these two 
fields and, as a practical matter, the 
need for joint, or adjacent, facilities to 
make coordination of the medical and 
non-medical disciplines effective. 

The Judge Baker had a decade 
ago — and still has — 120 staff, resident- 
in-training and graduate student per- 
sonnel, four or five times more than in 
the Hospital Department of Psychia- 
try. It is of importance to note that 
the Judge Baker has an invested en- 
dowment of approximately $4,000,000, 
whereas the hospital department has 
none definitely earmarked for use in 



FINANCIAL SHEET OF EXPENDITURES AND INCOME FOR PERSONNEL ONLY 



July 1, 1959 - June 30, I960 



Expenditures 

Psychiatrists 

Psychologists 

Psychiatric Social Workers 

Secretaries 



$55,152.00 

52,892.00 

32,278.00 

17,612.00 

$157,934.00 



This report is restricted to Personnel 
only. 

In addition to these grants for 
staff personnel, the Department re- 
ceived 24,000 to train Residents in 
Psychiatry and Clinical Psychology, all 
of whom contribute service to the hos- 
pital and its various clinics. Also not 
included in the above income are fees 
from clinic patients or patients from 
any of the outside units served by the 
Department. Important also is the fact 



Income from outside sources 

(USPHS; Commonwealth Fund; 

Hood Foundation; other) 

$38,672.00 

18,660.00 

11,483.00 

4,610.00 

$73,425.00 

that these figures do not reflect other 
income received by the hospital 
through this Department; viz, Over- 
head, Social Security, and Retirement. 
It is of importance to note that 
the personnel costs to the Hospital 
are not primarily in the medical dis- 
cipline of psychiatry but rather in the 
allied non-medical discipline of the 
"psychiatric team," namely, Psychol- 
ogy and Psychiatric Social Work. 



psychiatry. Nonetheless, in spite of 
these marked differences in numbers 
of personnel and resources, it was felt 
that if the Judge Baker were to carry 
out correctly its existent and future 
programs in the interest of child men- 
tal health, the unit needed the obvious 
values accruing in a meaningful affilia- 
tion with the Children's Medical 
Center. 

In the fall of 1953 the Judge 
Baker Child Guidance Center became 
an affiliate of the Children's Medical 
Center, and coordination of the ac- 
tivities of the Judge Baker and the 
newly established Hospital Depart- 
ment of Psychiatry was begun. This 
coordination is still in progress. In 
1957 the Judge Baker occupied its 
new building on Longwood Avenue, 
directly opposite The Children's Hos- 
pital. This new building contains fa- 
cilities for the traditional out-patient 
child guidance work of the Judge 
Baker, plus facilities for two units for 
additional and new functions. 

First in importance was an in- 
patient service, a unit that opened in 
September of 1958. This unit is a 
twenty-six bed in-patient service 
which gives psychiatric care and edu- 
cation to children who need to be 
treated away from their own homes. 

During 1959-60 there was an 
average of seventeen in-patient chil- 
dren on these two wards, and at the 
time of this report there are twenty- 
two. Needless to say, this in-patient 
psychiatric section has added new op- 
portunities for research and training, 
and the staff and students of the hos- 
pital unit participate in its operation 
or receive training there. 

The second new division, the 
Manville School, took its first patient 
in October 1957, and in the year 
1959-60 had thirteen pupils. This 
unit, which is essentially a psychiatric 
day care program, has proved its worth 



82 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



as a treatment and training center. 

The professional staff functions 
of both the Judge Baker and the Chil- 
dren's Hospital Department follow in 
most essential details the team work 
structure of the traditional child psy- 
chiatry clinic. The psychiatric team is 
usually composed of a psychiatrist, 
psychiatric social worker, and a clini- 
cal psychologist. In most instances the 
psychiatrist treats the child while the 
mother meets with a trained social 
worker. The traditional function of 
the clinical psychologist was diagnosis 
and research, but in recent years these 
roles have been expanded. The clini- 
cal psychologist now does counseling 
under psychiatric supervision in these 
medical settings. In the Judge Baker- 
Children's Hospital Division of the 
Medical School Department of Psy- 
chiatry, there are at present approxi- 
mately 150 professionally trained peo- 
ple, most of whom are allied with one 
of the three professions mentioned 
above. However, in the last three years 
there have been added to these cate- 
gories people trained in (and for edu- 
cation in) education, sociology, and in 
anthropology. 

In commenting upon the func- 
tions of this Division of Child Psy- 
chiatry in respect to education, train- 
ing and research I will emphasize the 
coordinated relationships which we 
have established with 

1. The Harvard Medical School 

2. The Harvard Department of 
Social Relations at the gradu- 
ate level 

3. The Harvard Graduate School 
of Education 

4. The undergraduate instruction 
in Harvard College and Rad- 
cliffe College 

5. The Harvard School of Public 
Health. 

I also will emphasize the present 
and future relationships of this Divi- 



sion with the following Medical 
School departments: 

1. The Department of General 
and Adult Psychiatry 

2. The Department of Pediatrics 

3. The Division of Child Neu- 
rology. 

CHILD MENTAL HEALTH 
EDUCATION FUNCTIONS 

Medical School Education 

First Year. The members of this Divi- 
sion at the Judge Baker and The Chil- 
dren's Hospital offer lectures and 
clinics in that segment of the new 
curriculum entitled Growth and De- 
velopment. These lectures, with illus- 
trative clinical material, stress normal 
personality growth in children. The 
various tasks in personality develop- 
ment set for the child are outlined, 
together with the crises and threats 
that may block or divert the normal 
process of maturing. 

Second Year. In association with 
the Department of Pediatrics, lectures 
are given to the second year medical 
students which include the differential 
diagnosis of various types and grades 
of mental retardation, childhood 
schizophrenia, and emotionally deter- 
mined learning blocks. 

Third Year. To the third year 
medical students, six lectures are given 
on the most frequently encountered 
childhood neuroses and psychoses. 

Fourth Year. In association with 
the Department of Pediatrics of The 
Children's Hospital, there are 
( 1 ) weekly clinical exercises on the 
responses of children to the effects of 
hospitalization, and (2) a two-hour 
session held with the fourth-year stu- 
dents at the Massachusetts Mental 
Health Center, dealing with the prob- 
lems of adolescents. 

In addition, the members of the 
Psychiatry Department take part in 
the clinical education of the Harvard 
Medical School students: There are 



weekly two-hour teaching conferences 
at the hospital and at the Judge Baker. 
In association with the Division of 
Pediatrics at the Hospital, the depart- 
ment supervises psychiatric teaching 
of fourth-year medical students in the 
Well Child Clinic and Family Health 
Care program; this program is in the 
Family Health Services. There is a 
month's elective course in child psy- 
chiatry offered at the hospital to the 
fourth-year medical students. In this 
course the students interview both 
child patients and their parents and 
take part in the psychiatric consulta- 
tions of staff members with patients 
on the wards. They also attend teach- 
ing conferences and the research con- 
ferences at The Children's Hospital 
and at the Judge Baker across the 
street. 

Department of Social Relations 
(Graduate Level) 

Since the establishment of the Depart- 
ment of Social Relations in the Uni- 
versity in 1946, the Judge Baker has 
been used as a field training unit for 
the clinical psychologists following the 
curriculum in that department. These 
teaching functions have been carried 
out at The Children's Hospital as well. 
In the past academic year six students 
at the second year graduate level have 
been assigned to the Judge Baker- 
Children's Hospital Division for an 
internship in clinical psychology 
throughout the academic year. 

There are two-hour graduate 
seminars (Social Relations 296A and 
296B given at the Judge Baker each 
week throughout both the Fall and 
Spring terms). The second-year grad- 
uate students in the Division of Clini- 
cal Psychology of the Department of 
Social Relations are required to take 
this seminar. These seminars include 
the orientation of the student in clinic 
practices and offer instruction in the 



83 



DEPARTMENT OF PSYCHIATRY 



diagnosis and counseling of child 
patients and their parents. 

Harvard Graduate School of 
Education 

Beginning with the fall term 1957, 
Dr. Samuel Waldfogel, formerly the 
Director of Research at the Judge 
Baker, was appointed a Lecturer on 
the faculty of the School of Education. 
At the present time, he spends one half 
of his time in course work on the 
other side of the Charles River and 
one half of his time with us at the 
Judge Baker and the Hospital, as the 
supervisor of graduate students from 
that school. 

Dr. Waldfogel and Professor Tiede- 
mann of the School of Education be- 
gan their first clinical course for the 
training of educational psychologists 
in clinical practices in the Fall of 
1957. They set up field training units 
both at the Judge Baker and in the 
Newton School Counseling Unit, the 
latter under the direction of Dr. 
Edward Landy. 

During the past year, two of the 
students of the School of Education 
received Tinkham Fellowships from 
the Judge Baker, and two students of 
the School of Education received Man- 
ville Fellowships from the foundation's 
grant given to the School of Educa- 
tion. 

In the Spring term eight students 
from the Graduate School of Educa- 
tion were admitted to Dr. Gardner's 
middle Group Course, Social Relations 
187 (The Emotional Problems of 
Childhood and Adolescents). 

For the next academic year 
( 1960-61 ) Dr. Edleff Schwaab of our 
staff will also hold an appointment as 
a Lecturer in the School of Education. 
Instruction of Undergraduates in 
Harvard College and RadclifFe 
College 
Two courses to which undergrad- 



uates are admitted are given in the 
Department of Social Relations: Social 
Relations 187 in the Spring term, 
taken by approximately fifty under- 
graduates, and during the Fall term, 
Social Relations 131, dealing with the 
"Social and Psychological Aspects of 
the Practices of Medicine" and given 
by Dr. Gardner and Dr. Croog, an 
anthropologist who holds a joint ap- 
pointment in the Department of Social 
Relations and at the Hospital. This 
course is offered to pre-medical stu- 
dents and to seniors concentrating in 
Social Relations. During the fall term 
there were fifty to sixty students tak- 
ing this course. Other members of the 
Hospital staff, besides those in the 
Psychiatry Department, assist in offer- 
ing this sequence of lectures on med- 
ical care and the meaning of disease to 
the patient. 

GRADUATE TRAINING PROGRAM 

I would like to turn now to post- 
doctoral residency training in child 
psychiatry as carried out by the Judge 
Baker-Children's Hospital Division in 
Child Psychiatry. The entire child psy- 
chiatry division of the Department of 
Psychiatry at the Medical School com- 
prises the largest residency training 
program in child psychiatry in the 
country. Training in this area began 
at the Judge Baker in the 1930's, and 
it has been due largely to affiliation 
with the Medical School that the divi- 
sion has grown to its present size. With 
Dr. George Berry's help and guidance, 
we now have seven fully approved 
and fully accredited training clinics in 
child psychiatry, including The Chil- 
dren's Hospital and the Judge Baker. 
All these clinics have residency train- 
ing. Some of them train medical stu- 
dents and non-medical pre- and post- 
doctoral fellows: and all are engaged 
in research in child psychiatry. 

In the Judge Baker-Children's Hos- 



pital coordinated training program in 
child psychiatry, we have had fourteen 
full-time residents in training during 
the academic year 1959-1960. These 
men and women work on both sides 
of Longwood Avenue and study a 
variety of childhood emotional dis- 
orders with close supervision of the 
psychotherapy. In addition, they fol- 
low the course of didactic exercises 
which have been set up for the Har- 
vard Training Program in Child Psy- 
chiatry and which all residents of the 
clinics in the Harvard orbit are re- 
quired to attend. 

In addition to the residents men- 
tioned above, we have residents from 
the programs of training in general 
psychiatry at the Massachusetts Mental 
Health Center and the Boston State 
Hospital; they come to the division for 
orientation in child psychiatry but do 
not intend to become specialists in this 
field. 

Lectures also are given to pe- 
diatric residents at The Children's Hos- 
pital. There is on-the-job training of 
pediatric residents in the various out- 
patient clinic areas in the hospital. 

On Friday mornings throughout 
the year, the residents on the Medical 
Out-Patient Department present cases 
for discussion to the Psychiatrist-in- 
Chief. 

The Department of Psychiatry 
furnishes the Child Health Program 
with four hours of consultation per 
week and these consultation hours also 
are devoted in large part to the in- 
struction of both pediatric residents 
and medical students. Two hours are 
spent interviewing mothers before a 
one-way mirror as a teaching device 
for the demonstration of interview 
technique. Two hours are devoted to 
participation in teaching discussions 
with the staff of the program and the 
third year Harvard Medical Students. 
The psychiatric implications of child 



84 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



rearing practices, the dynamics of fam- 
ily interactions, and normal growth 
and development are discussed. 

In addition, we furnish periodic 
consultations on specific cases for 
which the staff requests assistance. We 
participate in the occasional policy 
meetings on the teaching aspects of 
the program. 

Finally, weekly instruction is of- 
fered by members of the Department 
through the psychiatrist assigned to 
the Family Health Care Program of 
the Hospital. 

The most important part of the 
work is not to teach psychodynamics 
or the theory of psychopathology, but 
to contribute from psychiatric experi- 
ence and personality theory pertinent 
information for understanding "nor- 
mal" family interactions, the psycho- 
logical reactions to medical illness, the 
significance of the doctor-patient rela- 
tionship, and the psycho-social aspects 
of medical practice. These items have 
been dealt with as they came up in the 
course of case discussions or when a 
student requested a consultation about 
a particular family. The general prob- 
lems that students might encounter in 
their roles as new doctors have been 
discussed without mixing into their 
private affairs gratuitously. 

An additional function is to dis- 
cuss with the physicians and students 
the genesis and management of psy- 
chiatric disorders in their patients as 
these arise in the course of the year. 
Whenever possible, direct diagnostic 
or therapeutic contact with the patients 
has been avoided, the students and 
trainees manage the necessary suppor- 
tive therapy when feasible and other- 
wise supervise the referrals for defini- 
tive psychiatric treatment with the help 
of the Social Worker, Mrs. Brenner. 

It is important to add that selected 
staff members and students from the 



Children's Mission to Children are 
present at these exercises. 

Training in the Social Sciences 

During the past year we have had four 
post-doctoral students in training in 
clinical psychology in the Judge Baker- 
Children's Hospital unit. 

Five years ago the Judge Baker 
received a training grant from the 
United States Public Health Service to 
establish a model training program for 
personnel to work in the field of juve- 
nile delinquency. This grant was for 
$100,000 per year for five years and it 
is in its write-up stage. The various 
installations organized for the training 
of students (both physicians and non- 
medical personnel) are the Judge 
Baker Guidance Center, units at the 
Boston Juvenile Court and the Cam- 
bridge Court, and the Newton School 
Counseling Center. This course in 
1959-60 included clinical training in 
these various installations plus lectures 
and seminars. Enrolled at the moment 
are child psychiatrists, students from 
the Harvard Graduate School of Edu- 
cation, students from the Department 
of Social Relations, men from the 
Divinity School, and students from the 
law school. 

During the academic year, 1957- 
58, the Medical School, in conjunction 
with the School of Public Health, and 
the Department of Social Relations, 
established a training program for 
social scientists in the medical field. 
These three divisions of the Univer- 
sity organized this program with the 
help of a five-year grant from the 
United States Pubic Health Service. 
The Division of Child Psychiatry, like 
the various divisions of the department 
of general psychiatry, takes part in the 
instruction of these men and women 
who wish to apply social science meth- 
ods to the study of problems of health. 



RESEARCH 

In the year 1959-60, the Judge Baker 
and Children's Hospital psychiatric and 
social science personnel took part in 
a coordinated program of research on 
the following aspects of normal and 
abnormal child development: Anorexia 
nervosa, school phobias, seizures, juve- 
nile delinquency, childhood schizo- 
phrenia, the effects of congenital de- 
fects upon personality development, 
impairment of the learning process in 
normal children, basic studies in pat- 
terns of child personality development. 

Much of this research concerns 
the problem of aggression and counter- 
aggression in children. We hope to 
throw light on the expression of this 
instinct and control of it. These pro- 
grams are carried out under grants 
from the United States Public Health 
Service, the Hood Foundation, and 
from the Scottish Rite Foundation for 
Research in Dementia Praecox. 

Dr. Peter Wolff, a United States 
Public Health Service Career Investi- 
gator, is carrying out research studies 
on babies in the first twenty-four hours 
of life. 

Dr. Sidney Croog, an anthropol- 
ogist, is concluding a study of The 
Children's Hospital and its allied units 
as a community child health center. 
Dr. Croog is a Research Fellow of the 
Russell Sage Foundation. 

Dr. Eric Lennenberg, a United 
States Public Health Service Career In- 
vestigator, in 1959 began his work on 
speech development and speech path- 
ology, his aim being to study the devel- 
opment of speech and language from 
physiological, neurological, and psy- 
chological viewpoints. This research 
may lead to new diagnostic tools in the 
examination of children with abnormal 
speech behavior; may give new in- 
sights for the management of speech 
and language disability, and, most im- 
portant of all, may provide new data 



85 



DEPARTMENT OF PSYCHIATRY 



concerning the biological prerequisites 
of speech development in the human 
infant. Dr. Lennenberg's research 
grant is for five years. 

Dr. Geraldine Rickard and Dr. 
Haskel Cohen, through Funds from 
the Hood Foundation and the Wolbach 
Fund, are developing a psychological 
test to determine children's progress 
in emotional development. The aim is 
to perceive basic patterns in relation to 
the selected tasks of emotional devel- 
opment. With such information on 
norms psychiatric personnel would be 
better equipped to determine the areas 
in which emotional problems exist. 



FUTURE NEEDS AND 
ITEMS FOR DISCUSSION 

In the foregoing survey I have out- 
lined the treatment, training and re- 
search activities and programs of the 
Department of Psychiatry of The Chil- 
dren's Hospital Medical Center in the 
year July 1959 to July I960. I have 
stressed those activities and work of 
the Department's personnel in the hos- 
pital proper and have included the co- 
ordinated work with the affiliated 
Judge Baker Guidance Center. In con- 
clusion, I would like to list needed new 
programs or needed expansion of ex- 
isting programs that would add to our 
effectiveness in dealing with the men- 
tal health problems and behavioral de- 
viation of children. I say "list" ad- 
visedly because almost all of these items* 
require the careful consideration of 
the Board ( or Boards ) of Trustees and 
the Chiefs of various services of the 
Hospital (and the Judge Baker) be- 
fore definite detailed outlines and pro- 
posals are blueprinted — and surely 
before cost and space requirements are 
defined. 

It is well to bear in mind, too, that 
in the past psychiatric programs to be 
carried out for either children or adults 



in a general hospital have had to 
evolve slowly and the need for them 
has had to be pressing to — and to be 
pressed by — the personnel in depart- 
ments other than Psychiatry itself. For 
example, although all medical person- 
nel may readily see the need for a new 
ophthalmological or nutrition division, 
or for an extension of a post-natal care 
program, the needs for this or that new 
program in the new field of child 
mental health are not so easily demon- 
strated or accepted. Child psychiatric 
care and prevention programs are 
usually expensive affairs. These re- 
peatedly demonstrated facts should be 
known and appreciated by trustees — ■ 
and most important of all, they should 
be known, appreciated, and understood 
by the psychiatrist who may be urging 
new or expanded programs. 

With these reservations in mind, 
I suggest a consideration of the follow- 
ing items (listed not necessarily in the 
order of their importance) in respect 
to future programs relevant to the 
mental health care of children at The 
Children's Hospital Medical Center: 

1. There is the need for a modest 
number of beds in The Children's Hos- 
pital with proper facilities for the care 
of child psychiatric emergency cases 
that are from time to time brought to 
our out-patient or emergency clinics, 
or that develop in the hospital on one 
or another medical or surgical services. 
Although we have twenty-six beds on 
the in-patient service at the Judge 
Baker, we are not equipped either by 
ward structure or personnel to handle 
the youngster who presents an acute 
behavioral emergency. 

2. We definitely need expansion 
of the psychiatric treatment and re- 
search facilities to include the infant 
and pre-school child, psychological 
testing programs, and, especially, pro- 
grams of training for clinical psychol- 



ogists who may, we hope, become spe- 
cialists with this particular age group. 

3. There is a need to include men- 
tal health principles and mental health 
personnel in the recreational and edu- 
cational programs for in-bed and con- 
valescent patients. I am referring here 
specifically to the already nationally 
recognized programs that are being 
carried out at the Floating Hospital 
under Dr. Tisza, and at the Boston 
City Hospital under Dr. Gellis. 

4. With the contemplated estab- 
lishment of a new Department of 
Neurology it is hoped that cooperative 
schemes of training, treatment, and 
research will go forward. It seems to 
me that with an expanded and defini- 
tive Department the widest spectrum 
of cases of both the organic neurolog- 
ical and the emotional-behavioral type 
could be cared for within our own 
Children's Hospital Medical Center. 
It presents an opportunity for a broad 
and eclectic treatment program, and 
for a training and research approach 
to these disabilities of childhood. 

5. The possibilities for the ap- 
pointment of one or two full-time psy- 
chiatrists to our staff should be ex- 
plored seriously. In the Department 
of Psychiatry — as in some of the other 
departments of the Hospital — the lack 
of outstanding "personnel in depth" 
constitutes, to my mind, a serious situ- 
ation, in the evolvement of future 
treatment and research programs and 
in the maintenance of a Harvard teach- 
ing program of high quality. 

6. I have already presented to 
the Chiefs of Staff and to the Director 
of Development of the Hospital the 
hope that monies may be found for 
the establishment by Harvard Medical 
School of a professional chair in child 
psychiatry at The Children's Hospital. 
It seems to me that The Children's 



86 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Hospital is the logical and sensible 
place for such a chair. 

7. To turn to present-day needs 
for a moment, I recall writing to the 
administration in 1954 a detailed out- 
line of the pressing need in the de- 
partment for (a) added support for 
the treatment facilities in the Central 
Psychiatry clinic and (b) a more real- 
istic view of the psychiatrist-psychiatric 
social worker ratio in that clinic. Both 
of these needs are pressing and our 
work could be greatly enhanced by 
meeting them if this is at all possible 
at the present time. 

8. It is our hope that through the 
help of Dr. Janeway we will be able 
to find stipends for a year's training in 
child psychiatry for those appreciably 
large numbers of board-eligible pedia- 
tricians (25 or more per year) who 
apply to the Department for such 
training. Thus far we have not been 
able to secure these stipends, though 
both Dr. Janeway and I have tried 
various possible sources over the past 
two years. 

9. Finally, looking as objectively 
as possible at the present relationships 
between the Judge Baker department 
and The Children's Hospital Medical 
Center department of psychiatry, I 
think beginning discussions relative to 
the future administrative unification 
of these separate departments would 
be profitable. Such discussions, of 
course, should involve the Chiefs of 
Staff of the Hospital, Dean Berry of 
the Medical School, the Trustees of 
the Children's Hospital Medical Cen- 
ter, the Trustees of the Judge Baker 
Guidance Center, and the staffs of both 
the Judge Baker and the Hospital De- 
partment. Under the affiliation status 
the two departments, it is true, have 
developed over the past six years many 
coordinated and cooperative programs 



as outlined above, and this cooperation 
will probably go on apace in the years 
immediately ahead. However, it is my 
feeling that preliminary exploratory 
discussion relative to the possible inte- 
grations of these two departments 
should begin. 

George E. Gardner, Ph.D., M.D. 
Psychiatrist-in-Chiej 



Bibliography 

Blitzer, J. R., Children who starve them- 
selves. Anorexia-nervosa. J. Psycho- 
som. Med. (In press.) 

Caudill, W., Observations on the cul- 
tural context of Japanese psychiatry. 
In Opler, M. (Ed.), Culture and 
Mental Health, Macmillan, 1959. 

, Relationship of anthropology 

to psychiatry in the study of culture 
and personality. Jap. J. Psychoanal., 
1959. 

, Similarities and differences in 



psychiatric illness and its treatment 
in the United States and Japan. 
Mental Hygiene, Seishin Eisei, 1959. 

Fineman, A. D., Preliminary observa- 
tions on ego development in children 
with congenital defects of genitouri- 
nary system. Am. J. Orthopsychiat., 
29(1): 110, 1959. 

Gardner, G. E., Adjustment difficulties 
during adolescence. In Stuart, H. G, 
and Prugh, D. G. (Eds.), The 
Healthy Child: His Physical, Psycho- 
logical and Social Development. 
Harvard, I960. 

, Discussion of: Rosenbaum, 

M., Role of psychological factors in 
delayed growth in adolescence. A 
case report. Am. J. Orthopsychiat., 
29:769, 1959. 

-, Juvenile delinquency as a 



development task failure. U. S. 
Public Health Service Publications, 
1959. 

-, Mental retardation as part 



of the training program in child 
psychiatry. In Bowman, P. W., and 
Mautner, H. V. (Eds.), Mental Re- 
tardation: Proceedings of the First 
International Medical Conference. 
Grune & Stratton, I960. 
, Observational research with 



emotionally disturbed children: Ses- 
sion II. Symposium, 1958. Discus- 
sion. Am. J. Orthopsychiat., 29:590, 
1959. 
, Psychiatric problems of ado- 



87 



DEPARTMENT OF PSYCHIATRY 



lescence. In Arieti, S. (Hd.) , Ameri- 
can Handbook of Psychiatry, Vol I. 
Basic Books, 1959. 

-, The public's right to know. 



Symposium. /. Nat. Prob. & Parole 
Assoc, 5:431, 1959. 

Kaufman, I., Frank, T., Heims, L., 
Herrick, J., and Wilier, L., Four 
types of defense in mothers and 
fathers of schizophrenic children. 
Am. J. Orthopsychiat., 29:460, 1959. 

Lenneberg, E. H., Language, evolution, 
and purposive behavior. In Culture 
in History: Essays in Honor of Paul 
Rodin. Columbia, I960. 

, Review of Penfield, W., and 

Roberts, L., Speech and Brain 
Mechanisms. Language: 36, No. 1, 
I960. 

Makkay, E. S., Adolescent girls. In 
Stuart, H. E., and Prugh, D. G. 
(Eds.), The Healthy Child: His 
Physical, Psychological and Social 
Development. Harvard, I960. 

, Meaning and use of relation- 
ship in freeing adaptive functions of 
the ego. Case Studies Smith Coll. 
Sch. Soc. Wk. (In press.) 

-, Some problems in the differ- 



ential diagnosis of pre-delinquency 
in early latency. /. Am. Acad. Child. 
Psychiat. (In press.) 

-, Kaufman, I., and Zilbach, J. J., 



Impact of adolescence on girls with 
delinquent character formation. Am. 
J. Orthopsychiat., 29:130, 1959. 

Waldfogel, S., Emotional crisis in a 
child. In Burton, A. (Ed.), Case 
Studies in Counseling and Psycho- 
therapy. Prentice-Hall, 1959. 

, Tessman, E., and Hahn, P. B., 

A program for early intervention in 
school phobia. Am. J. Orthopsychiat., 
29:324, 1959. 

Wolff, P. H, Developmental psycholo- 
gies of Jean Piaget and psycho- 
analysis. In Psychological Issues, 
Vol. II, No. 1, Mono. 5. Interna- 
tional Universities Press, I960. 



, Discussion of: Chambers, J., 

Maternal deprivation and the con- 
cept of time in children. Am. J. 
Orthopsychiat., 31:416, 1961. 
, Observations on newborn in- 
fants. Psychosom. Med., 21:110, 
1959. 



89 



DEPARTMENT OF RADIOLOGY 



REPORT OF 
RADIOLOGIST-IN-CHIEF 



When the annual statistics of the De- 
partment of Radiology are compared, 
it is evident that the increase in the 
work load of the Department is to 
some extent predictable. An increase 
approaching 10 per cent annually is to 
be anticipated. There has been but 
one exception, the year 1957. In that 
year there was a great deal of pub- 
licity about the hazards of radiation. 
Through methods of mass commu- 
nication facts already known to ra- 
diologists were made public, some- 
times in a distorted and exaggerated 
form. The reaction of fear and worry 
may well account for the diminution 
in the rate of increment during that 
year. In spite of an increase in the 
work load and the complexity of the 
examination, our records indicate that 
the number of films used per examina- 
tion has presumably leveled off to the 
reasonable figure of approximately two 
and three-quarters films per examina- 
tion. 

It is also possible to predict in 
a rough way the accretion in staff 
needed to carry out satisfactorily the 
increasing load placed upon the De- 
partment. The studies that have been 
made suggest that one radiologist 
should attempt to handle no more 
than 10,000 cases per annum, and 
it is probable that in a teaching hos- 
pital this figure should be consider- 
ably lower. An increase of 2000 com- 
plicated examinations warrants one 
more technician and this, of course, 
necessitates the addition of other key 
personnel to maintain the smooth 
functioning of the Department. 

During the past few years radi- 
ography as a science has entered an 
almost revolutionary era. With rapid 
advances in electronic techniques, 
new methods of radiological explora- 
tion are now available that are safer 
for the patient and diagnostically 
more rewarding. Image amplifiers, 



television techniques and moving pic- 
tures or cinefluorography are now 
routine procedures in the Department. 
The Hospital must anticipate in the 
future considerable capital expendi- 
ture so that the very latest advances 
in these new techniques may be ap- 
plied to the care of children, to re- 
search and to teaching. To cite but 
a single example, the present image 
amplifiers give over a 3000-fold light 
gain, enabling the radiologist to re- 
duce the amount of x-radiation to the 
patient to almost one-fortieth of that 
given before. At the same time the 
image is vastly improved so that 
lesions barely detectable by the older 
modalities now become clearly evi- 
dent, and can be demonstrated on tele- 
vision and recorded on movie film. 
The Hospital must not lag behind 
either in the application of these few 
facilities in the Department of Ra- 
diology or in eagerly anticipating the 
use of television for teaching, research 
and patient care in other areas of the 
Hospital. 

The research activities of the De- 
partment continue with a number of 
fields of major interest. The division 
of Radiotherapy under Dr. Giulio J. 
DAngio has been investigating Ac- 
tinomycin D in combination with 
x-ray therapy, particularly in regard 
to normal tissue effects, effect on ani- 
mal tumor systems and comparison 
with other chemotherapeutic agents. 
At the same time search is being con- 
tinued for other radiation sensitizers, 
such as the nitrofurans. A third area 
of research is the comparison of the 
effects of the particulate radiation 
(high speed electrons) and electro- 
magnetic radiation (x-rays) on the 
growing bones of rabbits. Other in- 
vestigators are collaborating in these 
studies. Included among them are Dr. 
Charlotte L. Maddock of the Children's 
Cancer Research Foundation and Mr. 



90 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Kenneth Wright of Massachusetts In- 
stitute of Technology. 

The division of Radiotherapy 
also provides the technical facilities 
for other investigators pursuing many 
differing experiments. Among those 
using the facilities of the Department 
are Drs. Alfred H. Handler and Rich- 
ard Adams working on the irradiation 
of tumor-bearing hamsters, these stud- 
ies having to do with chemotherapeu- 
tic agents and in the immune mecha- 
nisms of tumor-host relationships. Dr. 
John F. Enders and his associates are 
utilizing x-ray therapy in their studies 
employing tissue culture techniques 
on leukemogenesis and virology. Dr. 
Carl Partanen has used x-radiation in 
conjunction with his studies on spon- 
taneous tumors developing in the fern, 



while Drs. Hans Meier and Maddock 
have worked on bone marrow trans- 
plantation in irradiated rats and Dr. 
David Gitlin on adrenal function of 
mice in relation to irradiation. These 
studies and others utilizing x-radiation 
equipment and the services of Dr. 
D'Angio and his staff indicate that 
his division has been very active in- 
deed. Although there has been no 
notable change during the past three 
years in the number of patients 
treated, approximately 3,600, the very 
active research program has and will 
contribute a great deal toward the 
understanding of a number of im- 
portant problems. 

Mr. Eric Hammond, the Techni- 
cal Assistant to the Department of 
Radiology, has done significant re- 



search in methodology and in the en- 
gineering of new equipment. He has 
worked closely with the Keleket Com- 
pany in developing the now functional 
forms of image amplification. In addi- 
tion to his activities within the De- 
partment, Mr. Hammond has been 
helpful in planning and development 
for the Departments of Cardiology, 
Pulmonary Physiology and Dentistry. 
The demand for his knowledge and 
experience has become so great that 
it is difficult to keep his activities 
from becoming unproductively dif- 
fuse. 

The research activities of the 
Diagnostic division have continued on 
the physiology of pulmonary hyper- 
tension, the development of the man- 
dible in the fetus and newborn, the 



SUMMARY FOR THE DEPARTMENT OF RADIOLOGY 










Year Ending 


September 30, 1959 


Old cases 


New cases 


X-Ray 






Month 


Films 


Diagnostic 


Diagnostic 


Therapy 


1959 
Total Films 








74,453 


October 


6,139 


1,517 


678 


319 


Total Diagnostic Cases 


27,095 


November 


5,844 


1,457 


676 


289 


Total Treatments 


3,546 


December 
January 


5,752 
6,585 


1,409 
1,594 


681 
798 


307 
330 


1958 

Total Films 

Total Diagnostic Cases 


70,693 
25,337 


February 


5,744 


1,365 


642 


281 


Total Treatments 


3,676 


March 


6,074 


1,460 


724 


212 


1957 




April 
May 


6,392 
6,285 


1,499 
1,492 


804 
782 


246 
346 


Total Films 

Total Diagnostic Cases 

Total Treatments 


71,511 

25,123 

3,405 


June 


6,457 


1,585 


787 


400 


1956 




July 


6,814 


1,764 


785 


252 


Total Films 

Total Diagnostic Cases 


65,317 
23,000 


August 


6,185 


1,526 


741 


305 


Total Treatments 


2,419 


September 


6,182 


1,577 


752 


259 


1955 










8,850 


3,546 


Total Films 

Total Diagnostic Cases 

Total Treatments 


58,532 


Totals 


74,453 


18,245 


20,233 
2,191 



91 



DEPARTMENT OF RADIOLOGY 



complications of cystic fibrosis of the 
pancreas, and the utilization of aerosols 
in double contrast study of the large 
bowel. In addition, a number of small 
clinical programs are being actively 
pursued. 

The members of the Department 
have been particularly active in teach- 
ing. Mr. Hammond has taught a num- 
ber of classes at Northeastern Univer- 
sity in the courses for X-ray techni- 
cians. Two student technicians from 
the Saint John General Hospital, 
Saint John, New Brunswick, and one 
from the Peter Bent Brigham Hospi- 
tal rotate through the Department 
every three months. During the year 
twenty-six undergraduate or graduate 
medical students have spent one 
month or more in the Department, 
and it is probable that no Department 
in the Hospital conducts more con- 
tinuous teaching; at least one mem- 
ber of the Department is teaching 
every hour during the day. In addi- 
tion, the staff has been active on the 
national scene; some twenty-eight out- 
of-town lectures were given in the 
course of seventeen out-of-town trips. 
Committee appointments are held by 
all members of the Department in na- 
tional roentgen organizations. 

After completing his three-year 
term, Dr. Martin H. Wittenborg re- 
signed as Consultant to the National 
Institute of Health, where he served 
on the Clinical Studies Panel and the 
Experimental Design Committee of 
the Cancer Cooperative Studies Pro- 
gram; he has accepted appointment as 
member of the National Research 
Council Division of Medical Sciences 
of the National Academy of Sciences 
as representative of the American 
Roentgen Ray Society. The Radiolo- 
gist-in-Chief has served as President of 
the American Roentgen Ray Society 
and concurrently as the first President 
of the newly formed Society of Pedia- 



tric Radiology. It is of interest that 
of the charter members of this society, 
approximately two-thirds obtained 
their Pediatric Radiology training at 
The Children's Hospital of Boston. 

Increasing demands have been 
made upon the Children's Hospital 
Committee on Radiation Safety as a 
result of the increased activity within 
the Hospital, involving almost all 
services, of research using radioactive 
isotopes. The Committee acts in an 
advisory capacity as well as itself 
maintaining safety standards to protect 
patients and personnel against radia- 
tion hazards. Of this hard-working 
Committee of three, two are members 
of the Department of Radiology, Dr. 
D'Angio and Dr. Wittenborg, Chair- 



man. 



Drs. Eckart Sachsse, Urfan Jaw- 
hari, John Tampas, Robert Berk and 
Norman Sadowsky have served as 
Residents, while Dr. Sisir Bose from 
India served for over a year as a 
Rockefeller Fellow, Dimitrije Radjic 
as a Fellow from his own University 
at Kingston, Ontario, Dr. Mustaga 
Sipahi served as Rockefeller Fellow 
from Ankara, Turkey, and Dr. Ithamar 
Aviad as Hadassah Fellow from Is- 
rael. Among the Volunteer Assistants, 
there has been Dr. Vivian Harris 
from New York, Dr. Nurettin Eryil- 
maz from Turkey, Dr. Ernest Frinton 
from Vancouver, B. C, and Dr. Keith 
Rapp from Boston. 

Life in the Department of Radi- 
ology appears to be one of constantly 
increasing activity. On the whole, the 
affairs of the Department have run 
smoothly and the credit for this goes 
to the loyal and enthusiastic teamwork 
of every one of the thirty-four mem- 
bers of the Department. 

E.B.D. Neuhauser, M.D. 
Radiologist-in-Chief 



Bibliography 

D'Angio, G. J., and Brown, B., The 
potentiation of x-ray effects on 
normal mouse skin by actinomycin 
D. Proc. Am. Assoc. Cancer Res., 
3:103, 1960. 

D'Angio, G. J., Evans, A. E., and Mitus, 
A., Roentgen therapy of certain com- 
plications of acute leukemia in child- 
hood. Am. J. Roent., Rod. Therapy 
& Nuclear Med., 82:541, 1959. 

D'Angio, G. J., Farber, S., and Mad- 
dock, C. L., Potentiation of x-ray 
effects by actinomycin D. Radiology, 
73:175, 1959. 

Maddock, C. L., Brown, B., and 
D'Angio, G. J., Enhanced response 
of Ridgway osteogenic sarcoma to 
x-radiation combined with actino- 
mycin D. Proc. Am. Assoc. Cancer 
Res., 3:131, I960. 

Neuhauser, E. B. D, Planning the pro- 
gram. President's address to 60th 
annual meeting of American 
Roentgen Ray Society. Am. J. 
Roent., Rod. Therapy & Nuclear 
Med., 82:755, 1959. 



93 



DIVISION OF LABORATORIES AND RESEARCH 



DIVISION OF LABORATORIES 
AND RESEARCH 



The Division of Laboratories and Re- 
search was established on July 1, 1946, 
following a careful study of the needs 
of The Children's Medical Center and 
an evaluation of the opportunities of 
the hospital and all cooperating units, 
for the greatest contribution to Pedia- 
trics. 

The experience of the Depart- 
ment of Pathology during the preced- 
ing twenty years formed the basis of 
this new conception, which was de- 
scribed in terms of the utilization of 
technics of Biology, Chemistry, and 
Physics, applied to the several disci- 
plines of Immunology, Experimental 
Pathology, Pharmacology, Physiology, 
Genetics, and the like, for the solution 
of mental and physical problems con- 
cerned with the normal and with the 
sick infant, child, and adolescent. In 
addition to the performance of its own 
research, the Division of Laboratories 
and Research was organized to pro- 
vide expert professional assistance to 
the research programs originated and 
conducted by the several clinical de- 
partments of the hospital. 

The grouping together of all of the 
clinical routine laboratories in one de- 
partment of Clinical Laboratories has 
provided a professional competence 
and supervision of a caliber never be- 
fore realized, and has added impor- 
tantly to the hospital income. 

Only one of the planned labora- 
tories of research basic to Pediatrics 
was founded directly within the hospi- 
tal. This was the Laboratory of Infec- 
tious Disease Research, under Dr. 
John F. Enders. 

Because of developments which 
were both natural and fortunate, the 
outgrowth of the cancer research pro- 
gram in the Department of Pathology 
resulted in the creation of The Chil- 
dren's Cancer Research Foundation, in 
1948. This organization, now affiliated 
with The Children's Hospital Medical 



Center, provides the facilities for the 
Laboratories of Infectious Disease Re- 
search, and also for the many labora- 
tories — Chemistry, Biophysics, 
Pharmacology, Experimental Biology 
and Pathology, and Botany — in addi- 
tion to an Outpatient Clinic which 
cares for the largest number of chil- 
dren with leukemia and other forms 
of cancer in the world. 

DEPARTMENT OF PATHOLOGY 

This is the pioneer department of 
Pediatric Pathology, first under the 
late Dr. S. Burt Wolbach, who was as- 
sociated with it in a part-time capac- 
ity for almost forty years. The present 
Pathologist-in-Chief, Dr. Sidney Far- 
ber, has served the hospital continu- 
ously since 1927, and holds the posi- 
tion of Professor of Pathology, 
Harvard Medical School, at The Chil- 
dren's Hospital. Many of the impor- 
tant laboratories of Pediatric Path- 
ology in this country, Europe, and 
Latin America which have been or- 
ganized since World War II are 
headed by men who have received all 
or part of their training here. The 
laboratory continues to give training 
not only to pathologists, but also tc 
clinicians as a background to their 
future medical or surgical activities. 

The routine of the Department 
is the responsibility of Dr. Gordon F. 
Vawter and his Junior and House 
Staff. The work has been of high cali- 
ber and has been rendered with devo- 
tion and unselfishness not exceeded in 
any Laboratory of Pathology. The 
post-mortem examinations, which give 
information of such great importance 
to both doctors and the families of 
patients, are performed with thor- 
oughness of research endeavors, and 
are recorded with care. Dr. Vawter 
and his colleagues are always available 
to members of the Clinical Staff and 
render an enormous amount of assist- 



94 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



ance in the solution of their problems. 
Such help is difficult to identify and 
frequently is not sufficiently recog- 
nized. The willingness of a staff to 
carry out such a function, in addition 
to its own research activities, makes 
the difference between a great and an 
ordinary hospital. Dr. Vawter is main- 
taining a tradition which has been in 
operation without interruption for 
several decades. 

From July 1, 1959 to June 30, 
I960, the department performed 366 
autopsies, 113 guinea pig examina- 
tions for tuberculosis, examined 656 
bone marrow and 1517 other surgical 
specimens, and held 381 consultations. 
Members of the department in 
training included: 

John Craig Kosek 

Resident 
Ronald Garry Davidson 

Assistant Resident 
George Diamandopoulos 

Asst. Resident (6 mos.-PBBH) 
Raymond McBride 

Asst. Resident (6 mos.-PBBH) 
Herman Polet 

Asst. Resident (6 mos.-PBBH) 
Francis W. Sullivan 

Intern 
Donald Singer 

Intern 
Edward Gerber 

Voluntary Assistant with 
duties of Intern (5 mos.) 

The department supplied two 
one-day-per-week instructors for Har- 
vard Medical School Pathology, and 
an instructor for one unit in Patho- 
physiology. A fourth-year medical 
student from Duke University and a 
second-year medical student from Jef- 
ferson Medical College each spent two 
months in the department. Additional 
hours of formal teaching of Harvard 
Medical students were irregularly 
scheduled. Members of the depart- 
ment provided instruction for The 



Children's Hospital Medical Center 
Nursing School, Harvard Postgraduate 
Course in Cardiology, and the Boston 
University fourth-year Pathology 
course. The departmental conference 
schedule has been continued, and 
Clinical Pathological Conferences con- 
tinue to be supplied to the Journal of 
Pediatrics at the rate of one per 
month. 

The contributions of Dr. J. Le- 
Roy Conel, continuous since 1931, are 
recorded in volume after volume de- 
scribing the development of the brain 
at various age levels. Dr. Conel has 
continued to work actively for many 
years since his official retirement. His 
contribution is recognized the world 
over, and forms the basis for evalua- 
tion of the development of the brain 
and of behavior patterns in infants 
and children. 

It is sad to record the loss of Dr. 
J. Lewis Bremer, at the age of eighty- 
five. He continued to work produc- 
tively almost to the end. His book on 
the embryologic basis of congenital 
malformations, published by the Har- 
vard Press shortly before he died, rep- 
resents a major contribution to Pedia- 
trics, Embryology, and Surgery. Dr. 
Bremer was an inspiration to the 
young members of the Staff during 
the eighteen years he worked in the 
Department of Pathology after his of- 
ficial retirement as Professor of Em- 
bryology at Harvard Medical School. 

The latest addition to the De- 
partment of Pathology came three 
years ago when we established the 
Subdivision in Neuropathology, under 
the leadership of Dr. Betty Q. Banker, 
a doctor expertly trained as a neurolo- 
gist as well as a neuropathologist. 
This laboratory has grown even faster 
than we had hoped. Dr. Banker's 
valuable contributions to the profes- 
sional staff and to the teaching of 
medical students and house officers 



have been documented in a series of 
publications and hospital records. She 
has provided the basis for many ac- 
tivities in the Departments of Neu- 
rology and Neurosurgery. Excerpts 
from her annual report are included 
as she has written them. 

There follows selected portions of 
the reports of the heads of several 
subdivisions of the Division of Lab- 
oratories and Research. 

Neuropathology 

Dr. Betty Q. Banker 

The Neuropathology Laboratory is a 
unit within the Department of Path- 
ology. This laboratory was established 
by Dr. Farber three years ago. The 
group is comprised of several physi- 
cians, laboratory technicians, and a 
secretary. The functions of this group 
are multiple: 

1. The routine study of biopsy 
and autopsy material of neuropatho- 
logical interest. 

2. The special study of problems 
encountered in the course of the rou- 
tine study. 

3. The establishment of a teach- 
ing center for many to learn the basic 
fundamentals of neuropathology. 

4. The presentation of neuro- 
pathological material to the patholo- 
gists neurologists, neurosurgeons, and 
pediatricians. 

Scope of Work. Data from approxi- 
mately 80 per cent of the autopsies 
have been studied in this laboratory. 
Reports from each case are incor- 
porated into the pathology protocol. 
There is a wealth of opportunity for 
study because many problems in pedi- 
atric neurology are unexplored and un- 
described. In many diseases, there has 
been no attempt to study accurately, 
nor to understand the pathogenesis. 
This subject of Pediatric Neuropa- 
thology is truly in its infancy. 



95 



DIVISION OF LABORATORIES AND RESEARCH 



Personnel. The number of research 
fellows varies over the course of each 
year. Each year there has been a full- 
time fellow. In addition, residents 
from Neuropathology at the Massa- 
chusetts General Hospital rotate every 
three months for a two-month period 
at Children's Medical Center and a 
one-month period at the Warren 
Museum. 

Last year, one of our neuro- 
surgeons spent six months in the lab- 
oratory. Each year a travelling fellow 
from a European country has also 
joined our group. 

STAFF 

1. Betty Q. Banker, M.D. 

2. James Q. Miller, M.D. 

Fellow — National Institutes of 
Health. July 1, 1960-July 1, 1961. 

3. Olga M. Blair, M.D. 

Fellow— December 1, 1958-July 
1, 1960. 

4. Frederick Horner, M.D. 

Fellow — November 1, 1958-May 
1, 1959. 

5. Jeanne-Claudie Larroche, M.D. 
Rockefeller Fellow — January, 
1959-August I960. 

6. James Robertson, M.D. 



Fellow in Neurosurgery CHMC 
—September, 1959-AprU, I960 

7. Gerald Winkler, M.D. 

Fellow in Neuropathology MGH 
— September, 1959-December, 
1959. 

8. William J. McEllroy, MD. 
Fellow in Neuropathology MGH 
—January 1960-April I960. 

9. Daniel B. Drachman, M.D. 
Fellow in Neuropathology BCH 
— February I960. 

10. Chim Mayman, M.D. 

Fellow in Neuropathology MGH 
—May 1960-July I960. 

11. Federiko Lopez, M.D. 

Fellow in Neuropathology MGH 
—June 1960-October I960. 

12. Alexander McPhedran, M.D. 
Fellow in Neuropathology MGH 
July 1960-October I960. 

Conferences. There is a great demand 
for teaching conferences by the neurol- 
ogists, neurosurgeons, and other 
groups in the city. Although these 
meetings serve as a stimulus, too much 
time in the course of one day is spent 
in conferences. At the present time, 
for the size of the senior staff, a typi- 
cal week is shown below. 



CONFERENCES IN NEUROPATHOLOGY 


Purpose 




Day 


Time 


Place 


Group 


Monday 
Tuesday 
Thursday 


9-12 


Neuro- 
pathology 


Routine 
Microscopic 


Neuropathology 


Wednesday 


9:30-10:30 


Pathology 
Library 


Neuropathology 
Presentations 


Neurology and 
Pathology 


Friday 


9-11 


Autopsy 
Room 


Weekly Gross 
Neuropathology 


Pathology and 
Neuropathology 


Friday 
q 2 weeks 


4-6 


Autopsy 
Room 


Clinical 

Neuropathology 

Conference 


CH.M.C. and 

Boston City 

Hospital 


Saturday 
q 2 weeks 


9-10 


Pathology 
Library 


Microscopic of 
Brain tumors 


Neurosurgery and 
Neuropathology 



Presentations in 1939-1960 

1. Banker, Betty Q. 

Occlusive Cerebral Vascular Dis- 
ease in Infancy and Childhood. 
American Neurological Associa- 
tion, Atlantic City, June 1959. 

2. Craig, John M. and Banker, Betty Q. 
Atypical Form of Gargoylism. 

American Pediatric Society, Buck 
Hill Falls, May 1959. 

3. Byers, Randolph K. and 
Banker Betty Q. 

Muscle Disease in Infancy and 
Childhood (A Ten-year study). 

International Pediatric Congress, 

Montreal, July 1959. 

4. Robertson, James and 
Banker, Betty Q. 

Spongy Degeneration in Infancy 
and Childhood (A Clinical Patho- 
logical Study). 

American Academy of Neurol- 
ogy, April I960. 

5. Banker, Betty Q. and Larroche, J. C. 
Non-Progressive Periventricular 
Leukomalacia. 

American Association Neuro- 
pathologists, Boston, June I960. 

6. Byers, Randolph K. and 
Banker, Betty Q. 
Werdnig-Hoffmann's Disease. 

American Neurological Associa- 
tion, Boston, June I960. 

7. Banker, Betty Q. 

The Experimental Studies in Peri- 
ventricular Leukomalacia. 
American Academy of Neuro- 
surgery, Boston, October I960. 
Projects. The following work is in 
progress and should be in press within 
the next few months: 

1. Spongy Degeneration of In- 
fancy 

2. Arthrogryposis Multiplex Con- 
genita 

3. Periventricular Leukomalacia 

4. Werdnig-Hoffmann's Disease 
(Infantile Spino-Bulbar Mus- 
cular Artrophy). 



96 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Work in progress 

1. Experimental Studies of Cere- 
brovascular Distribution in Periven- 
tricular Zones. Injection studies em- 
ploying the Schlesinger technique have 
been started in an attempt to define 
the vascular supply in the periventric- 
ular zones of brain. The frequent 
necrosis of white matter of the new- 
born occurs in characteristic zones in 
deep white matter. We postulate that 
these lesions are related to the "border 
zones" of the three major cerebral 
vessels. However, proof of such is 
lacking, because no investigations of 
cerebral blood supply have included 
these deep key zones. We shall also 
attempt to demonstrate a difference in 
vascularization of brain in the pre- 
mature, newborn, and mature brains. 

2. Dermatomyositis. A clinical- 
pathological study of dermatomyositis 
is in progress. The purpose of this 
project is to study carefully the vascu- 
lar factors in this disease and to define 
accurately the pathological changes. 
Material will be studied from children 
dying before steroid therapy was em- 
ployed as well as from those who have 
had the benefit of such treatment. 

Recommendations 

1. More space. With the expan- 
sion of this group, we are desperately 
in need of more space. Our research 
fellows have been working in a small 
passageway (fire exit) next to the lab- 
oratory, and in the slide file room. 
These rooms have no ventilation in 
the summer, are dark, and the passage- 
way is cold and drafty in the winter 
time. 

2. The future. At the end of 
three years of uninterrupted work in 
the Neuropathology Laboratory, I do 
not cease to be amazed at the wealth 
of opportunity here for study, and the 
challenge of studying diseases about 



which nothing has heretofore been 
learned. 

THE RESEARCH DIVISION 
OF INFECTIOUS DISEASES 

Personnel 

During this period the following in- 
dividuals have participated regularly 
in the work of the Division: 

John F. Enders, Chief 

Sidney Kibrick, M.D. 
Research Associate 

Samuel L. Katz, M.D. 
Research Associate 

Robert B. Berg, M.D. 

Postdoctoral Research Fellow, 
National Institutes of Health, 
U.SP.H.S. 

Melvin S. Rosenthal, M.D. 

Postdoctoral Research Fellow, 
National Institutes of Health, 
U.S.P.H.S. 

Marcel W. Pons, Ph.D. 

Postdoctoral Research Fellow, 
National Institutes of Health, 
U.S.P.H.S. 

James W. Mosley, M.D. 

Communicable Disease Center, 
U.S.P.H.S. 

Ion Gresser, M.D. 

Postdoctoral Research Fellow, 
The National Foundation 

Sumner Berkovich, M.D. 

Postdoctoral Research Fellow, 
The National Foundation 

Edward De Maeyer, M.D. 
Lederle International Fellow 

Monto Ho, M.D. 

Postdoctoral Research Fellow, 
Jane Coffin Childs Memorial 
Fund for Medical Research. 
In addition, the following under- 
graduates of the Harvard Medical 
School as special students received 
training in laboratory techniques and 
methods of research: 

Harvey Shein 

John Bachman 

Eliot Berson 

Alan Cooper 



Research 

As in the immediate preceding years, 
the research activities of the Division 
may be roughly divided into the fol- 
lowing categories: 

Studies on the development of a 
live attenuated virus vaccine 
against measles. 
Studies on virus-cell relationships. 
Clinico-laboratory studies of pa- 
tients with viral infections or 
those suspected to have viral 
infections. 
Other investigations. 
Measles Vaccine. Since our last report 
covering the period January 1, 1958- 
December 31, 1958, progress toward 
the development of a measles vaccine 
may be summarized as follows: 

Two vaccines were prepared for 
trial in susceptible children. These 
consisted of active virus of the Ed- 
monston strain attenuated by passage 
in chick embryonic tissues as de- 
scribed in a previous report. These 
vaccines were designated vaccine A 
and B respectively. The virus em- 
ployed as vaccine A had received a 
total of fifty-two consecutive passages 
in cultures of human kidney and am- 
nion cells, six passages in chick em- 
bryos and fourteen passages in cul- 
tures of chick embryo cells. Vaccine 
B consisted of virus subjected to six 
additional chick embryo passages and 
four chick cell passages. Vaccine B 
was prepared with the purpose of de- 
termining whether additional passages 
in chick cells might induce further 
attenuation. 

These vaccines have been tried in 
children by various groups of investi- 
gators located in different sections of 
this country. The first trial was car- 
ried out by Dr. Katz and Dr. Enders 
in an institution for children located 
in the vicinity of Boston. The results 
of these trials, which have been pre- 
sented in extenso in a series of papers 



97 



DIVISION OF LABORATORIES AND RESEARCH 



published in the New England Jour- 
nal of Medicine, may be summarized 
as follows: A total of 303 children 
received either vaccine A or vaccine 
B. No difference in the intensity of 
the clinical reactions were noted in 
those receiving vaccine B as compared 
with those in individuals receiving 
vaccine A. Thirty-one children were 
given the vaccine by the oral, intra- 
nasal, or conjunctival routes. Nearly 
all of these children failed to react to 
vaccine. The remaining 272 children 
received the vaccine subcutaneously. 
One hundred seventy-one of these chil- 
dren were considered to be susceptible 
to measles on the basis of serologic 
tests. Of these 165, or 96.5% subse- 
quently developed antibodies against 
the virus. Antibodies developing as a 
result of vaccination have been shown 
to persist for one and one half years in 
satisfactory concentration in the first 
group vaccinated. 

Clinical responses following vac- 
cination consisted of temperature ele- 
vations, appearance of a modified rash 
and in a few instances the presence of 
koplik spots, mild conjunctivitis, and 
slight coryza. Fever was recorded in 
83 per cent of 171 children considered 
to be susceptible and rash in 48 per 
cent. The average maximal tempera- 
ture (by rectum) was 102.4 degrees. 
Malaise and prostration were in gen- 
eral absent. Nearly all children con- 
tinued their normal activities through- 
out the post vaccinal period of three 
weeks during which they were ob- 
served. No complications attributable 
to the vaccine were noted. Virus was 
not recovered from the circulating 
blood of those studied or from the 
throat. 

In essence, then, the vaccine was 
found to induce a mild, much modi- 
fied benign infection that results in a 
prompt antibody response which tends 
to persist. 



Direct evidence for a high pro- 
phylactic efficiency of the vaccine 
within short periods after administra- 
tion was obtained by certain of the 
participating investigators. Dr. Saul 
Krugman of the New York Univer- 
sity School of Medicine reported com- 
plete protection in a group of twenty- 
three children vaccinated seven weeks 
previously and naturally exposed to 
measles in an institutional environ- 
ment. Among a control group of 
twenty-three unvaccinated children 
housed in the same ward seventeen 
developed measles. Lepow and her 
associates in Cleveland and Haggerty 
and his associates of The Children's 
Hospital Medical Center in Boston 
have followed twenty-one successfully 
vaccinated children who had no evi- 
dence of disease following intimate 
exposure to siblings with natural 
measles. 

More recently the vaccine has 
been administered by Dr. Harry 
Shwachman of The Children's Hospi- 
tal Medical Center, Boston, to about 
fifty children with pancreatic fibrosis. 
No severe reactions were observed in 
any of these children although some 
were in a debilitated condition result- 
ing from chronic disease. This group 
was selected because natural measles is 
frequently followed by serious illness 
in patients with pancreatic fibrosis. 

Dr. Frederick Gibbs and Dr. Ira 
M. Rosenthal in Chicago have taken 
electroencephalograms on approxi- 
mately forty children following vac- 
cination. In only one child was devia- 
tion from the normal pattern noted. 
This individual was suffering from an 
intercurrent respiratory infection. In 
a larger group with natural measles 
these workers found abnormal changes 
in about one half the cases. These 
negative findings in vaccinated chil- 
dren therefore give some assurance 
that the central nervous system is not 



affected following vaccination. 

In November I960 a small group 
of children were vaccinated in West 
Nigeria. In this country measles pre- 
sents an acute problem because of 
serious morbidity and significant mor- 
tality which follows the disease, ap- 
parently because many children suffer 
from various bacterial, protozoal, and 
helminthic infections and from mal- 
nutrition. The trial was carried out by 
Dr. Samuel L. Katz and Dr. David 
Morley, pediatrician at the Wesley 
Guild Hospital in Ilesha, West Ni- 
geria. Final data are not yet available. 
However, the clinical responses of 
these children did not differ signifi- 
cantly from those encountered with 
the vaccine in this country. It is hoped 
that arrangements can be made for 
more extensive trials in this area, al- 
though definite commitments have not 
yet been made. 

A number of American pharma- 
ceutical companies and at least one 
British firm are interested in the pos- 
sibility of producing the attenuated 
measles vaccine. Several have already 
manufactured vaccines which are 
under trial. Methods of freezing and 
drying the vaccine with preservation 
of viral activity have been developed 
by some of these manufacturers which 
will facilitate the distribution of vac- 
cine on a large scale should this be 
required in the future. 

Studies on Virus-Cell Relationships 
and on Biological Properties of 
Viruses. 

a) Interferon. An analysis of the 
production and effect on interferon or 
VIF ("viral inhibitory factor" as it is 
termed in this laboratory) in tissue 
cultures infected with measles and 
poliovirus was completed by Dr. Ho 
and the results published. Dr. De 
Maeyer extended these findings in re- 
spect to measles virus. He observed 



98 



PvEPORTS OF CHIEFS OF THE MEDICAL SERVICES 



that in cultures infected with the at- 
tenuated Edmonston strain the amount 
of interferon produced is signficantly 
greater than in cultures infected with 
virulent measles virus. Similar differ- 
ences in interferon production were 
found in cultures infected with at- 
tenuated (vaccine strains) poliovirus 
and those infected with virulent 
strains. These observations, if con- 
firmed and extended, may serve to de- 
fine one of the factors involved in 
viral attenuation. This would be 
helpful since the properties which de- 
termine virulence or lack of it are 
largely unknown. Such differences 
may also be of practical significance 
in affording additional "markers" 
whereby variants in respect to viru- 
lence can be distinguished. 

b) Effect of Cortisone on in vitro 
Viral Injection. In cultures infected 
with an unidentified simian virus, 
which under routine conditions of 
cultivation produces slight cytopathic 
effects, the addition of cortisone led to 
the development of widespread cellu- 
lar changes. This is the first instance, 
so far as we are aware, that cortisone 
in vitro has clearly enhanced the cyto- 
pathic effect of a virus. Results have 
recently been obtained suggesting that 
cortisone may act in this way by sup- 
pressing the production of interferon 
in this system. 

c) Multiplication of Measles 
Virus in Blood Leucocytes. In at- 
tempts to distinguish mechanisms that 
may account for the leucopenia so 
characteristic of many viral infections 
experiments were undertaken to deter- 
mine whether measles virus would 
multiply in blood leucocytes. Berg 
and Rosenthal found that this agent 
proliferated actively in suspensions of 
human and monkey leucocytes but not 
in those of certain other species in- 
susceptible to measles infection. Evi- 
dence was obtained that viral multipli- 



cation took place largely, if not en- 
tirely, in monocytic cells. 

d) Effect of Trypsin on Myxo- 
viruses. Because of its possible value 
as a criterion for the future classifica- 
tion of viruses as well as possible ap- 
plications to the study of viral struc- 
ture a study of the effect of trypsin on 
representative strains of myxoviruses 
was carried out by Dr. Ion Gresser. Its 
effect both on the infectivity and the 
viral hemagglutinin were examined. 
The results showed that these agents 
could be separated into three groups 
in accordance with the stability of 
these two properties: one group in 
which both properties were trypsin- 
resistant, a second in which infec- 
tivity was diminished but the hemag- 
glutinin was unchanged and a third in 
which both infectivity and hemagglu- 
tinin were impaired. 

e) Effect of pH and CO s Tension 
on Infection of Cells by Viruses. Re- 
search on the influence of these factors 
on cellular infection and resistance is 
currently in progress. 

Clinico-lab oratory studies 

a) Enteroviruses. Dr. Kibrick 
and Dr. Berkovich have carried out 
a virological and serological analysis 
of 137 cases of paralytic poliomyelitis 
occurring in this area in 1959. In all 
these cases Type III poliovirus was 
shown to be the responsible agent. 
Nearly one half of these cases occurred 
in children who had received three or 
more doses of Salk vaccine. The re- 
sults of this study indicate that the 
incidence of paralytic disease in vac- 
cinated individuals was significantly 
higher than in the rest of the country 
where the prevalent virus was polio 
Type I. Serologic data were obtained 
suggesting that the failures may have 
been due to vaccine of low antigeni- 
city since many of the cases exhibited 
no neutralizing antibodies for Type J 



virus. That failure of the host to re- 
spond to an effective antigenic stimu- 
lus was not responsible was indicated 
by the prompt development of Type 
III antibody during convalescence. 

b) Respiratory Viruses. Dr. Kib- 
rick continued the investigation of 
cases in the hospital with respiratory 
infections. In addition to the rather 
frequent isolation of Group Associated 
virus from patients of this class he has 
recovered a number of agents which 
have not yet been identified. 

c) Viral Infections of the New- 
born. Dr. Kibrick has also continued 
to examine materials of clinical and 
pathological interest from premature 
and newborn infants to extend our 
knowledge of disease due to viral 
agents in this age group. 

d) Completion of Studies on the 
Etiology of Giant Cell Pneumonia. 
Studies originally initiated by Doctors 
Kevin McCarthy and William 
Cheatham in 1955 on the role of 
measles virus in Hecht's giant cell 
pneumonia were extended and have 
been completed by Dr. Anna Mitus 
and her co-workers. The results have 
been published. It was shown that 
measles virus was responsible for the 
cases of this disease from which 
autopsy materials were available in 
The Children's Hospital Medical Cen- 
ter. Furthermore, in a correlated study 
of pneumonia following measles in 
leukemic children who were patients 
in The Children's Cancer Foundation 
clinic it was shown that the antibody 
response was markedly depressed. As- 
sociated with this effect was a persist- 
ence of virus in the oropharynx be- 
yond the normal limits. 

e) Isolation of Measles from the 
Urine. From six to eight patients with 
naturally acquired measles, the virus 
was isolated from the urine by Doc- 



99 



DIVISION OF LABORATORIES AND RESEARCH 



tors Gresser and Katz. This is the 
first time the virus has been demon- 
strated in the urine. It is of interest 
that in one case the agent was re- 
covered from the urine four days after 
the appearance of the rash. At this 
time attempts by various workers to 
demonstrate the agent in blood and 
throat secretions have failed. 

f ) Attempts to Cultivate the Vi- 
rus of Infectious and Serum Hepatitis. 
Dr. James W. Mosley of the Com- 
municable Disease Center, U. S. Pub- 
lic Health Service, has attempted to 
demonstrate the multiplication of 
these agents in various types of cul- 
tures of human cells. As criterion for 
viral multiplication it was considered 
that output of transaminase by the 
cells might become significantly al- 
tered. Accordingly, Dr. Mosley per- 
fected procedures for measuring these 
enzymes in cell cultures and applied 
them to a comparison of cultures 
inoculated respectively with materials 
considered to contain one of the two 
hepatitis viruses. No effect on trans- 
aminases (GOT and GPT) was ob- 
served. 

Other investigations 

a) An Inhibitor of Ribonuclease 
Activity. Dr. Marcel W. Pons investi- 
gated various substances capable of in- 
hibiting ribonuclease activity that 
have been described in the literature 
with the objective of determining 
whether any could be employed in cell 
cultures without injury to cellular ac- 
tivity. The only material that ap- 
peared to be at all promising was an 
inhibitor derived from lilac leaves, de- 
scribed by Bernheimer and Stack. As 
prepared by them the substance was 
mildly cyto-toxic. Dr. Pons devised a 
method of purification of the lilac 
leaf inhibitor which exhibits little or 
no toxicity. He then found that the 
inhibitor had no effect on the multi- 



plication of poliovirus — an RNA vi- 
rus — nor on measles virus. The inhibi- 
tor proved useful in studies involving 
the acridine orange staining of cells 
since the loss of RNA staining due to 
contaminating RNase in the prepara- 
tions was prevented by treatment with 
the inhibitor. 

b) Possible Presence of RNA 
Polymerizing Enzymes in Normal 
Horse Serum. During the course of 
investigation on the effect of various 
ammonium sulphate fractions of horse 
serum on ribonuclease activity of calf 
amniotic fluid, Dr. Pons noted an ap- 
parent increase of acid precipitable 
RNA in systems containing RNase, 
yeast RNA and the horse serum frac- 
tion. Inhibition of RNase by lilac leaf 
inhibitor prevented the apparent in- 
crease in precipitable RNA. Although 
the phosphorous in the precipitate was 
increased, pentose, as measured by the 
orcinol test, was not. The ultimate 
significance of these findings remains 
to be determined, but obviously if 
polymerization of RNA subunits is in 
the future clearly demonstrated under 
these conditions, the findings would 
be of much interest. 

Honors. In 1959, Dr. Katz was 
designated by the Boston Junior 
Chamber of Commerce as one of the 
outstanding young men of the year. 
Dr. Enders received, in I960, an hon- 
orary degree of Doctor of Science 
from Tufts University and Doctor of 
Humane Letters from the University 
of Hartford. He was also awarded the 
Cameron Prize in Practical Therapeu- 
tics by the University of Edinburgh. 

Publications. A list of papers written 
by members of the Division as well as 
those submitted for publication or in 
preparation is appended. (See p. 109). 



CLINICAL LABORATORIES 

Harry Shwachman, M.D., Director 
I960 

Personnel 

We have had a difficult time this past 
year because of the shortage of trained 
technicians. The turnover was some- 
what greater than usual. The main 
reason for the latter is marriage. 

Miss Anne Rush, the head tech- 
nician of our Hematology Laboratory, 
left to be married and she was re- 
placed by Mrs. Elaine Nelson, who 
recently resigned because of preg- 
nancy. 

Miss Barbara Williams and Miss 
Norma Baker continue as head tech- 
nicians in Chemistry and Bacteriology, 
respectively. 

In attempting to replace our tech- 
nicians, we have had assistance from 
the Personnel Office. We recently sug- 
gested that newspaper advertisements 
be placed in order to fill vacancies. 
Inasmuch as this is a problem common 
to all our local hospitals, a farsighted 
program might be considered which 
would establish a school for techni- 
cians. We have taken on a few in- 
dividuals for training purposes be- 
cause of need rather than a desire to 
operate a school. The Planning Com- 
mittee of the Hospital may consider, 
with profit, the establishment of a 
training school for laboratory tech- 
nicians. In this connection, affiliation 
with local colleges may provide the 
pioper basic science background for 
proposed students. 

Night Coverage 

In providing continuous twenty-four 
hour service, we have had the assist- 
ance of Harvard Medical School stu- 
dents, who serve as technicians during 
nights, weekends and holidays. This 
arrangement continues to be satisfac- 
tory. In view of the increased load of 



100 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



work that has been requested of our 
night technicians, many of our stu- 
dents had to drop out. We have in- 
creased coverage and have also made 
the position financially more attractive 
and in line with the opportunities the 
medical students have in other institu- 
tions in the city. 

Physicians 

We have suffered a sad loss in the 
death of Dr. Eva Fekete, who worked 
in the Bacteriology Laboratory on 
problems concerned with hospital in- 
fections and patients with cystic fibro- 
sis. One of her recent achievements 
was the demonstration by the Out- 
cherony technique of the presence of 
antibodies against Staphylococci in the 
serum of a series of patients with cys- 
tic fibrosis. She also demonstrated, for 
the first time in this institution, the 
presence of milk antibodies by the 
above technique in the case of a 
youngster who had chronic recurrent 
pulmonary symptoms. The presence of 
chronic pulmonary changes due to 
milk and the demonstration of anti- 
bodies to milk was pointed out by Dr. 
Heiner, formerly of the Medical 
Service. This one patient has shown 
considerable improvement following 
the removal of milk from the diet and 
is being followed by Dr. Cook. Dr. 
Fekete was assisting in the phage typ- 
ing of Staphylococci and was be- 
ginning to do special studies with the 
Pseudomonas which is now the most 
common terminal microorganism in 
patients with cystic fibrosis. 

Dr. Robert Rosan was a resident 
in the clinical laboratory and left on 
December 31, 1959, after completing 
one and one-half years with us. He 
was of considerable assistance while 
he was in charge of the laboratory, and 
in the clinical study of a selected 
group of patients with nutritional dis- 
turbances. Some of his investigative 



work resulted in a study of cystic fi- 
brosis patients from the point of view 
of tocophorol deficiency. He also 
worked on a small group of patients 
with cystic fibrosis, who developed 
diabetes. He performed tolbutamid 
tolerance tests in this group of pa- 
tients. We hope, in the near future, 
to have some of his observations in- 
corporated in a study of the complica- 
tions of cystic fibrosis. 

Dr. Lucas L. Kulczycki has been 
primarily involved in the care of pa- 
tients with cystic fibrosis and in the 
clinical problems related to this dis- 
ease. He is available to assist patients 
who come here for laboratory tests, 
and to lend a helping hand to any of 
our technicians when so called upon. 
His main income is derived from cys- 
tic fibrosis research funds. He also 
takes an active part in the Maine 
Medical Center Cystic Fibrosis Clinic. 

Dr. Ezra Elian, a Research Fellow, 
left us in July I960 after spending 
nineteen months with us. Dr. Elian 
was recommended by Dr. Matoth, who 
had formerly worked at The Chil- 
dren's Hospital Medical Center and 
now serves as his Chief in the Sharon 
Hospital, Petsh Tikva, Israel. Dr. 
Elian worked both in the clinic and in 
the laboratory on a variety of prob- 
lems. He was involved in chemical 
studies of sweat, the study of meco- 
nium, and in the development of im- 
proved technique for sweat testing. 
He also had an opportunity of learn- 
ing a variety of laboratory procedures 
and methods of investigation which I 
think will be of considerable help to 
him in his future work. He is a co- 
author of two papers which have been 
accepted for publication. 

Dr. Sami Kassim came as a part- 
time research fellow from Iraq. He 
formerly worked with us and has been 
familiar with the clinical management 
of patients with cystic fibrosis. Now, 



he spends half of his time with Dr. 
Massell in the Rheumatic Fever 
Clinic. His wife is a Doctor of 
Astronomy at the Harvard Observa- 
tory. 

Dr. Kon-taik Khaw came to us on 
July 1, I960 as a research fellow, after 
completing a residence with Dr. Gellis 
at the Boston City Hospital. He is of 
considerable help to us in the manage- 
ment of patients with cystic fibrosis, 
and in the routine laboratory. 

Dr. Mervin Silverberg spent from 
July 1959 to December 31, 1959 
working with us on the clinical prob- 
lems seen in our Nutrition Clinic. In 
addition to familiarizing himself with 
our program, he and Dr. Elian joined 
in carrying out an interesting clinical 
problem. They reviewed our patients 
with cystic fibrosis, who had previ- 
ously been hospitalized at The Chil- 
dren's Hospital and in whom the diag- 
nosis had not been suspected during 
hospitalization. Approximately twenty 
such patients comprise the series. It 
is our plan to broaden this project and 
present a report on the uncommon or 
previously unrecognized manifesta- 
tions of cystic fibrosis. Dr. Silverberg 
is now in Montreal in practice and 
spending part of his time at The Chil- 
dren's Hospital. 

Dr. Maria Nicholaidou left us on 
September 29, I960 for her home in 
Athens, Greece, after spending two 
years at this hospital. She spent ap- 
proximately nine months with us. Her 
studies on the amino acid content of 
plasma and red cells was done in the 
Laboratories of the Department of 
Physical Chemistry at the Medical 
School, in Dr. McMenamy's Labora- 
tory. She has worked independently. 
The source of her patients has been 
The Children's Hospital and the Bos- 
ton City Hospital. Dr. Nickolaidou 
was exposed to our methods in the 
clinical management and investigation 



101 



DIVISION OF LABORATORIES AND RESEARCH 



of patients with cystic fibrosis and 
celiac disease. She has high hopes of 
continuing her studies in nutritional 
problems when she returns home. 

Nutrition Clinic 

This clinic is designed primarily for 
long-term follow-up of children who 
have chronic nutrition problems. The 
majority of patients seen in this clinic 
are those having cystic fibrosis of the 
pancreas, celiac disease, and conditions 
resembling these diseases. In addition 
there are a small number of children 
with other metabolic or emotional 
problems in which growth and nutri- 
tion are affected. Between fifteen and 
twenty patients are seen in the clinic 
on each clinic morning. We now have 
three rooms in the Medical Out- 
Patient Department in which to see 
our patients, and a large teaching 
room, which, however, is not available 
until approximately 9:30 A.M. Since 
our clinic begins promptly at 9:00 
there has been some unnecessary loss 
of time. Furthermore, it is not con- 
venient to interview two people in the 
same large room. All in all, we are not 
entirely happy with our present ar- 
rangement, but we do understand the 
crowded conditions and facilities of 
the Medical Out-Patient Department. 
It is a great advantage to have a clinic 
where parents can come and discuss 
their problems. This is not as readily 
available as in our former quarters, 
where a large room for such conversa- 
tions could be had in semi-privacy. 

The clinic patients are also seen, 
from time to time, in our office area 
because of the type of care children 
with cystic fibrosis require. It is not 
uncommon for patients to telephone 
in for advice or to come and visit in 
our office area when medical problems 
arise. For patients for whom it is a 
great hardship to come on Fridays, we 
make special arrangements for one of 



our Fellows to see these patients on 
some morning during the week or on 
Saturday mornings, if this will ease 
the total family burden. We are for- 
tunate in having a fairly large number 
of our patients, approximately 240, en- 
rolled in the State Aid Program (the 
Crippled Children's Program of the 
Maternal and Child Health). This 
program provides antibiotics, either 
free, which is the case in most of our 
240 patients, or at a 50 per cent cost 
to a small number of people with 
moderate means and who could afford 
to pay for this. In addition, the $6.00 
clinic fee is paid to the hospital for 
each visit. Short-term hospitalizations 
are also provided by the State. My of- 
fice secretary keeps a record of the 
clinic visits and prepares a report for 
Dr. Rafuse periodically. When this 
program was started, approximately 
three years ago, we were required to 
write a brief report on each patient on 
each clinic visit. This tremendous bur- 
den has now been lightened so that we 
now are required to submit the name 
and date of each visit only. Resumes 
of cases are provided whenever Dr. 
Rafuse requests this information. 

Our clinic offers an opportunity 
for visiting physicians and parents 
from other parts of the country to 
learn more about the disease, cystic fi- 
brosis. A number of pediatricians 
have attended our clinic. Each patient 
is checked thoroughly and we devote 
approximately one hour per patient 
visit. Patients are sent to our physio- 
therapy department, as indicated. Spe- 
cial observations are made in line with 
some of our research activities. 

Since April of this year we have 
been able to inoculate our children 
with Dr. Enders' measles vaccine. This 
is rather an important prophylactic 
procedure because the appearance of 
measles in children with cystic fibrosis 
may begin a downhill course. At the 



time of this writing we have vac- 
cinated at least fifty children with rela- 
tively minimal reactions. Dr. Katz 
acts as our consultant in this project. 

We have also utilized some of 
our clinic patients for our studies in 
trying to develop improved techniques 
for diagnosis and one of our current 
projects is an attempt to use electrical 
conductivity measurements from the 
skin to determine if such a procedure 
could be developed which would do 
away with chemical analysis and pro- 
vide a much quicker and perhaps a 
better diagnostic test. This has not yet 
proven successful. We have the as- 
sistance of one of the scientists from 
Baird Atomic working on this project 
with us. 

Other special projects in which 
we have used the combined clinic and 
research area for our studies includes 
the following: the incidence of 
diabetes in cystic fibrosis, the fre- 
quency of allergy in a large group of 
patients with cystic fibrosis, the rela- 
tionship of nasal polyposis to cystic 
fibrosis, and the secretory function of 
the parotid glands. 

We feel that laboratory investi- 
gations form an intrinsic part in the 
proper management and study of the 
patients we see in our Nutrition 
Clinic. 

Maine Medical Center, Portland 

A brief statement concerning the 
Maine Medical Center is given be- 
cause we provide the supervisory and 
consultant staff. Nearly two years ago 
a clinic was established at the Maine 
Medical Center for the diagnosis and 
treatment of patients with cystic fi- 
brosis and related conditions. This 
clinic is under the joint auspices of the 
Center, the Maine State Health De- 
partment, Division of Maternal and 
Child Health (Dr. Ella Langer) and 
the Maine Cystic Fibrosis Chapter. 



102 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



The clinic meets once monthly and 
more frequently, if necessary. The at- 
tending staff consists of the local 
pediatricians in the Portland area, in 
addition to Dr. Kulczycki, one of our 
Fellows and myself. Either Dr. Kul- 
czycki or I supervise each clinic, with 
an attendance of from twelve to six- 
teen patients. I believe the roster of 
cystic fibrosis patients in this clinic is 
approximately sixty. 

Lectures and Exhibits 

1. American Academy of Pediatrics: 
Annual Meeting, October 3-5, 
1959. Address before the section 
of allergy on cystic fibrosis on 
October 4, 1959. 

2. Massachusetts State Grange, Au- 
ditorium, Springfield, October 28, 
1959. Acceptance speech for 
$7,000 contribution to cystic 
fibrosis research at The Children's 
Hospital Medical Center. 

3. Attended Seventh Antibiotic Sym- 
posium in Washington, D. C. 
Mayflower Hotel. November 4-6, 
1959. 

4. Visiting Professor, University of 
Puerto Rico, November 16-24, 

1959. (A report on this experi- 
ence submitted.) 

5. Radio — National Hookup on 
Cystic Fibrosis. February 11, 

1960. Local Broadcast March 7, 
I960. 

6. Award and special honors. Feb- 
ruary 13, 1960. Rhode Island 
Chapter of Cystic Fibrosis. 

7. Attended National Cystic Fibrosis 
Research Foundation meeting 
(Executives) in New York, 
March 10, I960. 

Presented report of Education 
Committee. 
H. New England Society of Allergy, 
March 30, I960, 
(a) Respiratory Allergy in Pa- 



tients with Cystic Fibrosis — 

Dr. Kulczycki. 
(b) Technique and Results of 

Sweat Analysis — Dr. Shwach- 

man. 
9. Evening speaker, Massachusetts 
CF. Chapter — April 2, I960. 
Evening speaker, Rhode Island 
CF. Chapter — April 30, I960. 
Evening speaker, Connecticut 
CF. Chapter — May 14, I960. 
Topic: Current Research in Cystic 
Fibrosis. 

10. Academy of Medicine, Cleveland, 
Ohio. 

Evening address on Cystic Fibro- 
sis— April 15, 1960. 
Afternoon — member of panel on 
cystic fibrosis. 

11. Society for Pediatric Research, 
Swampscott, May 2 and 3, I960. 
Participated in an all-day infor- 
mal session on cystic fibrosis: 
paper given from workers in 
U.S. and Canada. 

12. 69th Annual Meeting of Arizona 
Medical Association, Scottsdale, 
Arizona, May 4 to May 7, I960. 
Papers on 

(1) Staphylococcal Infections in 
Childhood. 

(2) Malnutrition in Childhood, 
on panel on Psychiatry in 
General Practice and the 
Specialties. 

13. Symposium on the Pancreas: 
Endicott House, Dedham, Mass. 
Chairman — Dr. Sidney Farber. 
Secretary — Dr. Shields Warren. 
Participant, May 23-25, I960. 

14. Central Maine General Hospital, 
Lewiston, June 8, I960. The 
Clinical Laboratory — New Tests 
and Interpretations of Laboratory 
Data. 

Other Lectures 

1. Occasional A.M. lecture in M.O.- 
P.D., Surgical and Orthopedic 



rounds and consultations. 

2. One Hour Lecture — 4 to 5 times 
during the year to nurses (Chil- 
dren's Hospital School of Nursing) 
on Cystic Fibrosis and Celiac 
Disease. 

3. Participation in organization and 
teaching of a one- week course 
(three given to date) for physio- 
therapists in the management of 
patients with cystic fibrosis. This 
course under auspices of our own 
Physiotherapy Department ( Miss 
Cogland and Mrs. Zausmer). 

4. Occasional lectures to Postgradu- 
ate students. 

5. Clinics or lectures in neighboring 
hospitals, such as: 

CP.C at Boston Floating Hospital, 

1-18-60. 
P.B.B.H. Grand Rounds, 3-18-60. 
B.I. Lectures, 4-18-60. 
Joslin Clinic, Lectures. Diabetes 

in Cystic Fibrosis, 1-25-60 
M.G.H. Informal discussion with 

G.I. group, 3-21-60 
B.L.I., CP.C, February 10, I960. 
North Shore Babies Hospital, 

Rounds, 2-15-60. 

Other Activities 

Member, Committee on Tuber- 
culosis and Respiratory Diseases in 
Children, American Trudeau Society. 
One year, 1959-60. 

Consultant, Pediatrics. Chelsea 
Naval Hospital. Seven visits per year. 

Secretary-Treasurer, New England 
Pediatric Society. 

Re-elected to office, 1960-1961. 

Chairman — Education Committee 
National Cystic Fibrosis Research 
Foundation. 

During the year received manu- 
scripts from a number of editors, re- 
questing opinion. 

Laboratory Equipment 

At the present time we are moderately 
well equipped. We can foresee need 



103 



DIVISION OF LABORATORIES AND RESEARCH 



for the Technicon Auto-analyzer, 
which will yield more reproducible 
results and will undoubtedly save tech- 
nician time if the volume of any one 
test is sufficiently great. At the present 
time it is estimated that the installa- 
tion of such an instrument will cost 
approximately $5,000. Once installed, 
such an instrument will process well 
over 100 determinations in one half 
day. Most of the major hospitals in 
this area already have one instrument 
and some, two. The volume of any 
one test in our laboratory is perhaps 
not sufficiently great to justify this 
expenditure at this time. However, if 
one or more determinations could be 
done, and if the volume of work is 
sufficiendy great, the acquisition of 
such an instrument will prove an eco- 
nomic advantage by elimination of one 
technician and by providing more con- 
stant uniform results than is possible 
by individual analysis by a variety of 
technicians. 

During this past year we have ac- 
quired a micro Beckman Spinco ana- 
lyzer, which is being explored for 
adaptation to the micro analyses of 
serum specimens. We have not yet 
utilized this instrument routinely, as 
it is still in the process of exploratory 
usage. 

The main chemistry laboratory ap- 
pears to be fairly well equipped and 
at present the only exception is the 
probable need for a new centrifuge 
this coming year as the current ma- 
chines are very old and have been re- 
paired so often that we have been 
advised that they will probably not 
last too much longer. One of our 
chemistry laboratories is in need of 
modernization and perhaps in the near 
future a plan can be worked out for 
this laboratory, which is room 3210. 

One of the problems that has re- 
cently come to our attention is stand- 
ardization of bilirubins. 



The bacteriology laboratory is, in- 
deed, cramped, and we are bursting 
at the seams. We are fortunate in 
having space made available in the 
Jimmy Fund Building for our entire 
phage typing program. Even here, at 
times, the space has been limited. We 
are in dire need of adequate laboratory 
space for the routine bacteriology lab- 
oratory. I should like to point out 
that the amount of work has increased 
tremendously in this laboratory over 
the past four years. There is serious 
need for a highly competent profes- 
sional bacteriologist to conduct the 
routine studies in this most important 
field. The lives of our patients liter- 
ally depend upon the quality of the 
work in this laboratory. The volume 
of work has so grown that more expert 
help is essential. 

We continue to participate in the 
State Approval Program and have re- 
ceived excellent reports from the State 
Laboratories concerning the identifica- 
tion of unknown specimens in a vari- 
ety of categories. This voluntary par- 
ticipation provides us with an ap- 
proval certificate which must be earned 
anew. 

The hematology laboratory is 
grossly inadequate in size for the num- 
ber of people working in it. 

The volume of work has increased 
again. The total number of individual 
tests is 159,317 — or four times the 
number carried our in the same space 
ten years ago! 

REPORT OF RESEARCH PROGRAM 

Conducted Jointly by the Departments 
of Orthopedic Surgery and Pathology of 
The Children's Hospital Medical Cen- 
ter and The Children's Cancer Re- 
search Foundation. 

By Dr. Jonathan Cohen, under the 
responsibility of Dr. William T. Green, 
with the cooperation of Dr. Sidney 
Farber. 



Personnel and Facilities 

During the present reporting period, 
many changes in personnel have taken 
place. John Burke continues to sup- 
ply outstanding technical, historical 
preparations. Animal care has been 
resumed under the direction of Cor- 
nelius Vos and has, therefore, been 
somewhat better than during the pre- 
vious period when his services were 
devoted entirely to other laboratories. 
However, animal care has remained 
a problem because of specialized needs 
of some animals under investigation 
with special techniques. The entire 
personnel of the laboratory, including 
secretary, technicians, and investiga- 
tive personnel, have collaborated to 
meet these needs, and this has worked 
out well. 

During the period of the present 
report, only two residents have been 
assigned for duty in the laboratory, 
in addition to Dr. Marvin Weinfeld, 
mentioned in the previous report. 
They are Dr. Arthur Pappas, who en- 
ters on a period of between eight and 
twelve months of laboratory service 
designed to provide him with basic 
science training and also to continue 
his investigative work, started at the 
National Institutes of Health. There, 
he was occupied with the problems 
of total body radiation and some prob- 
lems involving tissue culture of cells 
for the purpose of studying radiation. 
His immediate supervisor at the Na- 
tional Institutes of Health was Dr. 
Hyatt, who is in charge of the tissue 
bank at the Naval Medical School. 
Another resident who has begun his 
period of service in this laboratory is 
Dr. Seymour Zimbler, who is to serve 
from July 1 to December 31, I960. 
Dr. Zimbler 's period in the laboratory 
is to be devoted to study of basic sci- 
ence in preparation for his orthopedic 
training. 



104 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



With relation to the study on the 
Assay of Foreign Body Reactions, the 
employment of Mrs. Vida Barrs as a 
chemistry technician, has been a sta- 
bilizing influence on the needed chem- 
ical work done with relation to that 
program. Analyses for chromium, 
nickel, and molybdenum are now per- 
formed in routine fashion on many 
specimens as will be detailed below. 
Further elaboration of analyses on 
other elements in the metallic objects 
under investigation will be her prin- 
cipal methodological occupation in 
addition to the routines. Professor 
Licht mentioned in the previous re- 
port, has provided some of the con- 
sultation in chemistry which has been 
needed and in addition, the Chemistry 
Department at the Watertown Arsenal, 
in which Professor Licht and Bernard 
Mahoney, a previous employee of this 
project, have been active, are also now 
serving in that capacity. The collabo- 
ration of this laboratory has continued 
with the Radioactivity Center of the 
Department of Biophysics at M. I. T. 
(Dr. Robley Evans, Director) and 
with Dr. Constantine J. Maletskos of 
the Nuclear Reactor Laboratory, but 
more recently appointed to the Radio- 
activity Center. One of the achieve- 
ments of this collaboration has been 
the preparation of the report men- 
tioned below, and the furthering of 
the radium toxicity investigation now 
proceeding at the M. I. T. facilities. 

The control panel of the build- 
ing, having been finished during the 
period of the last report, the person- 
nel have enjoyed quiet working con- 
ditions during the period of this re- 
port. However, the prospect of new 
quarters elsewhere in the present build- 
ing has influenced greatly the plans of 
this laboratory, which are being ex- 
panded but with indefinite goals both 
as to space and time because of the 
lack of concrete knowledge as to when 



the new quarters will be available and 
how large they will be. 

The Saltonstall Laboratory in the 
main building of the hospital has con- 
tinued to serve well with regard to 
electromyography and histological 
studies. 

Work in Progress 

1. Radioactive Calcium Tracer 
Studies. The previously mentioned col- 
laboration with Dr. John Marshall of 
the Argonne National Laboratory has 
been completed and the publications 
listed below are the final results of 
this collaboration. 

2. The Dynamics of Strontium 
and Calcium Metabolism and Radio- 
element Removal. This study has 
seen publication as listed below, and 
no further work in this area is con- 
templated. However, a large amount 
of data previously accumulated in col- 
laboration with Dr. Maletskos, and 
which formed the basis of a publica- 
tion in 1957, but which was not in- 
cluded in that publication, has been 
revived for the purposes of a presenta- 
tion at a Symposium of the Interna- 
tional Society of Traumatology and 
Orthopedic Surgery to be held at 
Princeton from August 29 to Septem- 
ber 3, I960. The data, which related 
to the use of Ca 48 in the study of the 
disposition of bone grafts, proved of 
more general interest with respect to 
calcium metabolism and kinetics than 
to the graft problem. A differentia- 
tion between the puppies and dogs 
used in this experiment was easily 
made on the basis of serum levels of 
calcium and bone retention of cal- 
cium. This work has relevance to the 
problem of retention of radioactive 
isotopes in bone. It will be published 
in its entirety in the Proceedings of 
the meeting, which will include dis- 
cussions by twenty panel participants. 

3. Cathode Irradiation of Bone 



for Sterilization. This procedure de- 
veloped in this laboratory for use to 
supplement the sterile operative re- 
frigerated material available for clin- 
ical bone grafting, has been in opera- 
tion now for 5 years with no single 
failure attributable to the technique 
of preparation of the graft. Clinical 
failures of grafting procedure have not 
been recorded during this period and, 
therefore, although actual instances of 
failure of a minor type may have 
occurred, certainly no major failures 
are in evidence. It is impossible at 
the present time to make proper clin- 
ical evaluation of the material with 
relation to the degrees of clinical suc- 
cess, although no evidences of infec- 
tion or of undue disappearance of 
grafted materials have been evident. 
The procedure continues to be taken 
up by a number of institutions else- 
where in this country and abroad, and 
one of our former residents now in 
Athens, Greece, has begun to use the 
method under our supervision. 

4. Foreign Body Study. A precept 
that foreign material is entirely inert 
when imbedded in tissues has been the 
fundamental one in this study. This 
has been further confirmed and am- 
plified as a result of the work done 
during the last year in this depart- 
ment and has now achieved general 
acceptance. Given a large enough sur- 
face exposure to tissues, any material 
will cause appreciable tissue reaction. 
The preliminary experiments which 
were described in the previous report, 
and which concerned weight loss of 
objects of different metallic composi- 
tion when placed in different solutions 
under different gas liquid conditions, 
have been completed. None of these 
showed a consequential pattern of cor- 
rosion or weight loss and, therefore, 
these studies have been discontinued. 
To further the pursuit of the prob- 
lem of corrosion in metallic implants, 



105 



DIVISION OF LABORATORIES AND RESEARCH 



in vitro studies were devised where 
such metallic objects were placed un- 
der cyclic stress for long periods. This 
type of experiment was mentioned in 
the previous report as of a prelimin- 
ary nature, but in this report the con- 
clusion of several of these experiments 
have yielded definitive evidence that 
under these conditions of very slight 
cyclic stress, certain batches of metal 
will show marked corrosion, where in 
static solutions no corrosion was de- 
monstrable. These experiments are 
now being written up and will be 
available shortly as a definitive paper. 

The study of foreign body reaction 
in clinical materials which have been 
removed for one reason or another 
after implantation principally for frac- 
ture treatment, has become one of the 
principal studies of this laboratory. 
Over 180 of such devices are under 
active investigation at the present 
time. A further report of an instance 
of metallic failure of this type is being 
submitted to the Journal of Bone and 
Joint Surgery for publication, and in- 
dicates the type of investigations being 
followed. The author of this report 
continues his functions with regard to 
the national needs of the profession 
with regard to testing, regulation, and 
evaluation of metallic implants, which 
is under the supervision of the Bio- 
Mechanics Committee of the American 
Academy of Orthopedic Surgery. Ac- 
tive collaboration with the United 
States Pharmocopeia is being devel- 
oped in order to bring out some 
standards for these materials. Official 
evaluation of failures submitted to the 
Academy is being done. A course is 
being given at the Academy Conven- 
tion every year to provide interested 
individuals with the details of the 
problems of metallic implants. 

The functions of regulation of 
implants, principally directed at metal- 
lic objects, has been expanded under 



the Bio-Mechanics Committee juris- 
diction to include plastics. An ex- 
ample of the problems and occupa- 
tions of this laboratory with this 
material is evidenced by the recent 
furor over the clinical results obtained 
with a polyorithane plastic, commer- 
cially obtainable as Ostamer. The 
author of the present report, then a 
member of the Orthopedic Research 
Society Program Committee, was in- 
strumental in having this material 
evaluated and investigated. The nu- 
merous clinical failures which have 
been encountered have called for much 
more careful investigative work with 
such materials before they are released 
for public use. The manner of control 
of such release of materials is now 
under active investigation as indicated 
above, and it is hoped that the United 
States Pharmocopeia and/or the Food 
and Drug Administration will take the 
first steps toward official requirements 
concerning labelling, toxicology, etc. 

Haversian System Study. This 
study has been almost entirely in 
abeyance during the period of this re- 
port, owing to the lack of resident 
help and interest in this subject. How- 
ever, during the recent months just 
prior to the above date, a resumption 
of this study is being begun with the 
idea of learning about the recruitment 
of cells during the establishment of 
new haversian systems. The pressure 
studies mentioned in the previous re- 
port are still considered promising but 
are not being followed up for lack of 
personnel. 

Muscular Dystrophy. The clini- 
cal work pertaining to muscular dys- 
trophy and allied neuro-muscular con- 
ditions has progressed about at the same 
level during this period as previously. 
The patients who attend the muscular 
dystrophy clinic have continued to do 
so. The mechanical advantages pro- 
vided by the Surgical Appliance Shop 



have been extremely helpful and the 
summer camp facilities, previously in- 
stituted by this clinic with the col- 
laboration of one of the muscular dys- 
trophy organizations, has proved im- 
mensely beneficial to many patients. 

The electromyography service has 
continued to be rendered to The Chil- 
dren's Hospital and to the Peter Bent 
Brigham Hospital without charge. 

The study of muscle function and 
weight after removal of several 
muscles has been completed and is the 
subject of the report listed below. 

A study of the characteristics of 
the fluid from bone cysts has been 
completed and published. This study 
provides data relative to the patho- 
physiology of cysts and from them a 
theory of pathogenesis has been sug- 
gested. 

Miscellany 

One case report mentioned in the pre- 
vious Annual Progress Report has 
been published as listed below, and 
another has been submitted to the 
Journal of Radiology for consideration 
of publication. The activities of this 
laboratory also include several ad- 
ministrative and professional duties as- 
sociated with the duties of Dr. Cohen 
as follows: 

1. Committee on Bio-Mechanics 
and Metallic Implants, American 
Academy of Orthopedic Surgery. 

2. Committee on Pathology, ibid. 

3. Committee on Scientific In- 
vestigation, ibid. 

4. Chairman, Program Commit- 
tee, Orthopedic Research Society. 

5. Program Committee, Gordon 
Research Society, Conference on Bones 
and Teeth. 

6. Assistant Editor, Journal of 
Bone and Joint Surgery. 

New Work Begun During the 
Interval Covered by This Report 

First, a collaborative study with Dr. 



106 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Giulio J. D'Angio of the Department 
of Radiology has been begun, compar- 
ing the types of disturbance of bone 
which will be encountered when equal 
amounts of radiation of X-ray or of 
cathode ray are administered to rab- 
bits. Second, another investigation of 
the localized epiphyseal effects of 
radiation administered to small and to 
large volumes of tissue around epiphy- 
ses has been begun with Dr. Arthur 
Pappas. Third, an investigation of the 
effects in tissue culture of small metal- 
lic particles has been begun with Dr. 
Pappas. Fourth, a study of the effects 
on bone healing of radiation has also 
been begun. Fifth, a study of the pat- 
tern of growth of mouse and rat skulls 
is being started, in collaboration with 
Dr. Seymour Zimbler. 

THE CHILDREN'S CANCER 
RESEARCH FOUNDATION 

This institution is affiliated with The 
Children's Hospital Medical Center. 
It was an outgrowth of the Depart- 
ment of Pathology and most of the 
members of the staff hold appoint- 
ments in the Department of Pathology 
of the Medical Center. The clinical 
division of the Foundation is affiliated 
closely with the clinical divisions of 
the Hospital. 

The Foundation laboratories rep- 
resent a unique development. Their 
highly specialized facilities and funda- 
mental research programs are available 
to all members of the staff of the 
Medical Center. The laboratories are 
open to medical students and to care- 
fully selected high school and college 
students for research. The expert staff 
consists of scientists and medical doc- 
tors with training in Physics, Chemis- 
try and Biology. Their activities con- 
stitute programs of research which 
give a particularly broad and stimulat- 
ing definition to the term "Experi- 
mental Pathology." 



A complete report of the activi- 
ties of The Children's Cancer Research 
Foundation is being prepared by the 
Foundation. There is included here 
only brief mention of representative 
programs. No description is made of 
the clinical program of care and in- 
vestigation of leukemia and other 
forms of disseminated cancer in the 
young. This was the first program of 
its kind, and it remains the largest 
and most complete clinical unit in the 
field of childhood cancer in the world. 
More than 450 children at a time, with 
disseminated cancer, receive new 
treatments, proved in the laboratories, 
as part of their total care. The discov- 
ery of the first antimetabolite — a 
chemical agent — for the temporary 
control of acute leukemia, by Dr. Far- 
ber in 1947, marked the beginning of 
the era of antimetabolite cancer 
chemotherapy. Many forms of cancer 
in children have been controlled for 
months and years, and, in a small 
number, for as long as twelve years, 
by chemicals first used here. 

There may be mentioned, as an 
example of this program, a promising 
development which emanated from 
the demonstration by Dr. Farber in 
1954 of anti-cancer properties of 
Actinomycin D, an antibiotic dis- 
covered by Dr. Selman Waksman, in 
1940. In observations made by Dr. 
Farber and members of his staff, in- 
cluding Dr. Audrey E. Evans and Dr. 
Anna Mitus, in collaboration with Dr. 
Giulio J. D'Angio of the Department 
of Radiology, Actinomycin D was 
shown to increase the usefulness of 
small doses of X-ray against the com- 
mon kidney tumor of children, the 
Wilms' tumor, even after it had spread 
to the lungs. The lives of such chil- 
dren have been prolonged up to four 
years with no evidence of return of the 
scattered tumors, under a combination 
of treatment by this antibiotic and 



small doses of X-ray. The important 
contributions of the surgeons, mainly 
at The Children's Hospital Medical 
Center, in the surgical treatment of 
Wilms' tumor, had made possible the 
survival of more than 40 per cent of 
children suffering from this tumor. 
With the addition of chemical treat- 
ment to surgery, and radiotherapy 
from the time of first discovery of the 
tumor, the survival rate has increased 
markedly. A careful study of the long- 
term survival of patients so treated is 
now under way. It appears that for 
the first time there is a form of treat- 
ment for even widespread Wilms' 
tumor which has promise of being 
specific, and perhaps curative. Lab- 
oratory studies by Dr. D'Angio of the 
Department of Radiology and the 
Foundation, and members of the 
Foundation staff, including Drs. Char- 
lotte L. Maddock and Alfred H. 
Handler, are clarifying the mechanism 
of action of this antibiotic and are out- 
lining the possible fields of further 
usefulness in patients. 

Laboratories of Organic Chemistry, 
under the direction of Dr. Edward J. 
Modest. Here a pioneer program in 
the synthesis of anti-cancer chemicals 
has been going on since 1958. More 
than 300 new chemical compounds 
have been created. Some of these have 
had scientific interest in the field of in- 
fectious disease research and para- 
sitology, as well as cancer. 

Laboratory of Enzyme Chemistry, 
under the direction of Dr. S.-C. J. Fu. 
Fundamental studies on the mecha- 
nism of action of folic acid antagonists, 
of basic importance in the problem of 
acute leukemia in children, are in 
progress. 

Laboratories of Polypeptide Chemis- 
try, under the direction of Dr. Elkan 
R.. Blout and Dr. Gerald D. Fasman. 
This laboratory is concerned with the 



107 



DIVISION OF LABORATORIES AND RESEARCH 



synthesis of large molecular polypep- 
tides of possible importance as plasma 
expanders. These laboratories have 
pioneered in the development of arti- 
ficial materials which may act as 
artificial enzymes or portions of arti- 
ficial proteins. This is one of the two 
great laboratories in the world in this 
difficult new field of Chemistry. 

Laboratories of Pharmacology, under 
the direction of Dr. Marian F. Narrod. 
This laboratory is concerned chiefly 
with the action and toxicity of drugs 
which are studied by laboratory 
methods before they are employed in 
the treatment of patients with dis- 
seminated cancer. 

Laboratory of Bacterial Metabolism 
and Cell Biology, under the direction 
of Dr. George E. Foley. This is one of 
the first laboratories of this kind, and 
has participated in the creation of a 
whole new field of experimental bi- 
ology. More than 60 kinds of human 
cancer are grown in bottles in tissue 
culture. Expert consultation in bac- 
teriology is available to the hospital 
from this group of experts. 

Laboratories of Experimental Biology 
and Transplantation, under the direc- 
tion of Dr. Alfred H. Handler and Dr. 
Richard A. Adams. In this laboratory 
the pioneer work of Dr. Handler is 
carried out under ideal conditions for 
the growth of many types of human 
cancer in the cheek pouch of the ham- 
ster. Fundamental studies on the ef- 
fect of chemicals under these condi- 
tions, and the research concerning 
causation of cancer represent contribu- 
tions of major importance. 

Laboratories of Mechanism of Bleed- 
ing. Here Dr. Isaac Djerassi and Dr. 
Edmund Klein conduct a large pro- 
gram of research concerning the na- 
ture of bleeding in acute leukemia and 
after destruction of the marrow by 



ionizing radiation. They are concerned 
with a search for methods of protec- 
tion, prevention, and adequate treat- 
ment of massive hemorrhage. 

Laboratories of Experimental Hema- 
tology, under the direction of Dr. 
Giuseppe Cardinali. The mechanism 
of action of chemical compounds on 
cancer cells is studied to give informa- 
tion of basic importance in the ad- 
ministration of anti-leukemic agents. 

Laboratories of Genetics, under the di- 
rection of Dr. George Yerganian. 
These laboratories have acted not only 
as a research center in the field of ani- 
mal genetics, but also as a training 
ground for scientists responsible for a 
large part of genetic research in this 
part of the country. 

Laboratory of Experimental Pathology 
and Cytochemistry, under the direc- 
tion of Dr. Cecilie Leuchtenberger and 
Dr. Rudolf Leuchtenberger. This has 
been concerned with the possible role 
of viruses as causative agents of can- 
cer, as well as with fundamental cell 
biology. 

Laboratory of Experimental Botany, 
Dr. Carl R. Partanen. Pioneer studies 
on the nature of cancer produced in 
fern, yielding information of impor- 
tance to cancer chemotherapy in man, 
have been conducted here for the past 
three years. 

Laboratories of Biophysics and Crystal- 
lography. Here Dr. Carolyn Cohen, 
Dr. Donald L. D. Caspar, and Dr. 
Susan Lowey are conducting studies on 
the structure of proteins of viruses and 
the structure of muscle protein, by 
technics which they are developing as 
they pursue their fundamental studies 
in one of the newest and most promis- 
ing fields of medical science. 

Laboratory of Tissue Ultras tructure. 
Dr. Betty Uzman is continuing her 



basic contribution to the study of mye- 
lin sheath of the central nervous sys- 
tem, as well as of the peripheral 
nerves. Her studies have already given 
the stimulus for a new attack on multi- 
ple sclerosis and other diseases of the 
nervous system. 

Laboratories of Experimental Cancer 
Chemotherapy, under Dr. Charlotte L. 
Maddock. Our first macrobiological 
studies of the effect of chemical com- 
pounds on cancer are made on the 
mouse. There is an extensive and ex- 
pert pioneer program of experimental 
cancer chemotherapy. 

Laboratories of Enzyme Chemistry, 
under Dr. Morris N. Green and Dr. 
John T. Clarke. These laboratories 
work in conjunction with the Clinical 
Laboratories of Dr. Harry Shwachman, 
on studies of fundamental importance 
in the problems of cystic fibrosis. 

Laboratories of Immunochemistry, 
under Dr. Saul Malkiel. This labora- 
tory is concerned with the immuno- 
logical basis of infectious disease and 
of certain cancers. 

Laboratory of Biochemistry, under 
Dr. Adele Magasanik. This laboratory 
has been concerned, for the past nine 
years, first under Dr. Zelma Miller and 
then under Dr. Magasanik, with funda- 
mental metabolic studies of basis im- 
portance to our knowledge of the nor- 
mal cell and of the cancer cell. 

Laboratory of Lipid Chemistry and 
Studies of Lipidosis, under Dr. Allen 
C. Crocker. As part of a therapeutic 
attack on the problem of incurable 
disorders of heredito-familial nature, 
carried out by Dr. Farber and by Dr. 
Crocker, a Laboratory of Lipid Chemis- 
try has been set up under the immedi- 
ate direction of Dr. Crocker. Here 
facilities are available for more com- 
plete studies of the nature of these dis- 
orders in children than were ever pos- 



108 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



sible before. In addition, Dr. Crocker 
is directing his research to a basic 
understanding of the abnormal bio- 
chemical mechanisms within cells 
which are responsible for the devastat- 
ing effect upon the brain and organs 
of the body in these diseases. 

Sidney Farber, M. D., 

Chairman, 

Division of Laboratories and Research 



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to mammotropes, II. Hormone re- 
sponsiveness of 3-methylcholanth- 
rene induced mammary carcinomas. 
Proc Soc Exp. Biol. & Med., 
103:643, I960. 

, Relation of mammotropes to 



mammary tumors, IV. Development 
of highly hormone dependent mam- 
mary tumors. Proc Soc Exp. Biol. 
& Med., 103:490, I960. 

Kim, V., Furth, J., and Clifton, K. H, 
Relation of mammary tumors to 
mammotropes, III. Hormone re- 
sponsiveness of transplanted mam- 
mary tumors. Proc Soc. Exp. Biol. 
& Med., 103:646, I960. 

Kim, V., Clifton, K. H., and Furth, J., 
Highly inbred line of Wistar rats 
yielding spontaneous mammo-soma- 
totropic pituitary and other tumors. 
J. Nat. Cancer Inst., 24:1031, I960. 

Klug, A., and Casper, D. L. D., Struc- 
ture of small viruses. In Advances 



Ill 



DIVISION OF LABORATORIES AND RESEARCH 



in Virus Research, Vol. 7. Academic 
Press, I960. 

Leuchtenberger, C. L., Relation of the 
deoxyribosenucleic acid (DNA) of 
sperm cells to fertility. 7- Dairy Sci. 
(Suppl.) 43:31, I960. 

and Leuchtenberger, R., 

Quantitative cytochemical studies on 
the relation of deoxyribonucleic acid 
of cells to various pathological con- 
ditions. Biochem. Pharm., 4:128, 
1960. 

-, Deoxyribonucleic acid (DNA) 



variations in neoplastic and virus- 
infected cells. A cytochemical and 
cytopathological study. Cell Physi- 
ology of Neoplasia. University of 
Texas, I960. 

Leuchtenberger, C. L., Leuchenberger, 
R, Zebrun, W., and Shaffer, P., 
Correlated histological, cytological 
and cytochemical study of the 
tracheobronchial tree and lungs of 
mice exposed to cigarette smoke, II. 
Cancer, 13:721, I960. 

Leuchtenberger, R., Leuchtenberger, 
C, Zebrun, W., and Shaffer, P., 
Correlated histological, cytological 
and cytochemical study of the 
tracheobronchial tree and lungs of 
mice exposed to cigarette smoke, III. 
Cancer, 13:9%, I960. 

Maddock, C. L., D'Angio, G. J., Farber, 
S., and Handler, A. H., Biological 
studies of actinomycin D. Ann. 
N. Y. Acad. Sci., 89:386, I960 

Magasanik, A. K., and Bojarska, A., 
Enzyme induction and repression by 
glucose in Aerobacter aerogenes. 
Biochem. Biophys. Res. Commun., 
2:11, I960. 

Meier, H., Diabetes mellitus in animals. 
Diabetes, 9:485, I960. 

and Brown, B. L., Protective 

action of irradiated bone marrow 
cells. Separatum Experientia, xvi: 
145, I960. 

, A "runt disease" syndrome 



anemia and splenomegaly. /. Im- 
munol. (In press.) 

Mitus, A., Leuchtenberger, C, Leuch- 
tenberger, R., and Enders, J. F., 
Further studies of giant cell 
pneumonia (abstract). Am. J. Dis. 
Child., 100:615, I960. 

Modest, E. J., Foley, G. E., and Farber, 
S., Derivatives of 2, 4-diaminopy- 
rimidine as growth inhibitors. Extrait 
de Acta Union Internationale Contre 
le Cancer, xvi:10l, I960. 

Partanen, C. R., Amino acid suppres- 
sion of radiation-induced tumoriza- 
tion in fern prothalli. Science, 131: 
926, I960. 

, Amino acid suppression of 

radiation-induced tumorization of 
fern prothalli. Proc. Nat. Acad. Sci., 
46:1206, 1960. 

-, Endomitosis in a polyploid 



associated with immunohemolytic 



series of fern prothalli. /. Heredity. 
(In press.) 

Simmons, N. S., and Blout, E. R., 
Structure of tobacco mosaic virus 
and its components: ultraviolet 
optical rotatory dispersion. Biophys. 
J., 1:55, 1960. 

Steinberg, A. G, Genetics of acute 
leukemia in children. Cancer, 13: 
985, 1960. 

Swaffield, M. N., and Foley, G. E., 
Changes in the cellular content of 
ribonucleic acid, deoxyribonucleic 
acid and protein in cultured cells 
during logarithmic growth. Arch. 
Biochem. & Biophys., 86:219, I960. 

Uzman, B. G, and Villegas, G. M., 
Comparison of nodes of Ranvier in 
sciatic nerves with node-like struc- 
tures in optic nerves of the mouse. 
7. Biophys. & Biochem. Cytol., 7:761, 
I960. 

Wetlaufer, D. W., On terminology of 
protein structure. /. Am. Chem. Soc. 
(In press.) 

and Edsall, J. T., Sedimenta- 
tion of myosin in urea solutions. 



Biochem. Biophys. Acta, 43:132, 
1960. 

White, L. P., Influence of pH on the 
toxicity of nitrogen mustard. Science, 
131:1041, I960. 

, Linden, G, Breslow, L., and 

Harzfeld, L., Studies on melanoma, 
III. Effect of pregnancy on survival 
in human melanoma. J.A.M.A. (In 
press.) 

Yerganian, G, "Brittle-bristle": a sex- 
limited factor affecting only the 
female Chinese hamster, Cricetulus 
griseus. J. Heredity. (In press.) 

, Chromosomes of the Chinese 

hamster, Cricetulus griseus, 1. The 
normal complement and identifica- 
tion of sex chromosomes. Int. J. 
Cytol. (In press.) 

-, Cytogenetic analysis with 



reference to somatic cell genetics 
in vitro. Genetics Study Section and 
Division of General Medical Sci- 
ences, National Institutes of Health. 
(In press.) 
, Radiation effects on mam- 



malian sex chromosomes. Rod. Res., 
12:185, 1960. 

-, Farber, S., and Gagnon, H., 



Spontaneous hereditary diabetes 
mellitus in the Chinese hamster 
(Cricetulus griseus), IV. Probable 
inheritance pattern and the onset of 
symptoms. Diabetes. (In press.) 

Yerganian, G, Kato, R., Leonard, M. 
J., Gagnon, H. J., and Grodzins, L. 
A., Sex chromosomes in malignancy, 
transplantability of growths, and 
aberrant sex determination. In Cell 
Physiology of Neoplasia. University 
of Texas, I960. 

Yerganian, G, Leonard, M. J., and 
Gagnon, H. J., Chromosomes of the 
Chinese hamster, Cricetulus griseus, 
II. Onset of malignant transforma- 
tion in vitro and the appearance of 
the xi-chromosome. Pathol, et Biol. 
(In press.) 



112 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



Abstracts of Papers Presented at 
Meetings 

American Society for Experimental 

Pathology — April I960. 

Leuchtenberger, C, Stewart, S., Leuch- 
tenberger, R., and Eddy, B., Corre- 
lated microscopic and microspectro- 
photometric studies of DNA of 
tissues from mice and hamsters in- 
fected with polyoma virus. 

Maddock, C. L., Brown, B., DAngio, 
G. J., and Tedeschi, C, Histological 
studies of potentiation of x-ray ef- 
fects by actinomycin D on skin of 
normal mice. 

McCarthy, R. E., Modification of the 
homograft response in mice by 
ascites. 

Narrod, M. F., Some pharmacological 
studies of aglutamic acid-lysine 
copolymer. 

Wetlaufer, D. B., Degradation and 
reactivity of myosin in urea solu- 
tions. 

White, L. P., On the prevention of 
toxicity of nitrogen mustard. 

American Association for Cancer Re- 
search — April I960. 

DAngio, G. J., and Brown, B., Potenti- 
ation of x-ray effects on normal 
mouse skin by actinomycin D. 

Foley, G E., Friedman, O. M., and 
Drolet, B. P., Studies on the 
mechanism of action by Cytoxan, I., 
Evidence of activation in vivo. 

Handler, A. H, and Cohen, J., A trans- 
plantable ascites sarcoma in the 
Syrian hamster. 

Kato, R., Yerganian, G, Grodzins, 
L. A., and Stewart, S., Sex chromo- 
somes and transplantability (in vivo) 
of polyoma-induced sarcomas in the 
Chinese hamster. 

Kim, U., and Furth, J., Role of mam- 
motropic hormone in induction and 
growth of mammary tumors by 3- 
methylcholanthrene. 

Maddock, C. L, Brown, B., and 



D'Angio, G J., Enhanced response 
of Ridgway's osteogenic sarcoma to 
x-irradiation combined with acti- 
nomycin D. 
Tsukada, H., Kaneko, A. I., Onoe, T., 
and Fu, S.-C. J., Comparative studies 
on respiratory metabolism of sensi- 
tive (4N) and nitromin-resistant 
Ehrlich ascites tumor cells. 
White, L. P., Anti-tumor activity of 

non- toxic preparations of HN2. 
American Association of Pathologists 
and Bacteriologists — April I960. 
Yerganian, G, Green, M. N., and 
Meier, H., Spontaneous hereditary 
diabetes mellitus in the Chinese 
hamster: pathologic, biochemical, 
and genetic findings. 
Vlllth Congress, International Society 
of Blood Transfusion — September 
1960. 

Djerassi, I., Farber, S., Evans, A., and 
Yoshimura, H., Observations on 
transfusions of fresh human platelet 
concentrates. 
Yoshimura, H, and Djerassi, I., Studies 
on the hemorrhagic tendency in 
heparin-treated animals. 
Vlllth Congress, International Society 
of Hematology — September I960. 
Djerassi, I., Yoshimura, H., and Roy, 
A., Effects of soybean phosphatides 
on bleeding in thrombocytopenic 
rats and dogs. 
Roy, A., Yoshimura, H, and Djerassi, 
I., Hemostatic effects of heterologous 
platelets in thrombocytopenic rats. 
Yoshimura, H, and Djerassi, I., Obser- 
vations on oxygen uptake by human 
platelets. 
Tokyo Symposium on Cancer Chemo- 
therapy — October I960. 
Farber, S., Current clinical and experi- 
mental studies in cancer chemo- 
therapy. 
American Chemical Society — Septem- 
ber I960. 

Fu, S.-C. J., "Nitrogen mustard" of the 
folic acid side chain — N-bis (cbioro- 



ethyl) -p -ami no benzoyl -glutamic 
acid. 

Chatter jee, S., DuBois, E. P., and 
Modest, E. J., Synthesis of 4, 5- 
pentamethylenepyrimidines as poten- 
tial growth inhibitors. 

Lemlein, S. A., Chatterjee, S., Foley, 
G E., and Modest, E. J., Growth 
inhibition studies with selected 6, 
7-disubstituted pteridines. 

Modest, E. J., Chatterjee, S., Lemlein, 
S. A., and Brun, D. M., Synthesis 
of certain 4-mercaptopyrimidine 
derivatives. 



113 



DEPARTMENT OF OTOLARYNGOLOGY 



DEPARTMENT OF 
OTOLARYNGOLOGY 

This is a brief report on the aaivities 
of the Otolaryngology (Ear, Nose and 
Throat) Service for I960. During 
this year our patient load continued to 
remain high on the in-patient service 
insofar as admission and operations 
were concerned. However, despite this 
an economic and nursing problem was 
created for the hospital since most of 
these patients were in for throat op- 
erations (tonsillectomy and adenoidec- 
tomy) and remained in the hospital 
for less than 30 hours. A word of ex- 
planation for this situation might be 
in order. A "T. & A." is an elective 
operation performed on a well child 
and in most instances requires very 
little in the way of a hospital workup, 
the patients having been previously 
examined by at least two doctors be- 
fore admission was decided upon. The 
average age of these patients is about 
*>Vl years. Admission to the hospital 
occurs early on the morning of opera- 
tion and the child is escorted to the 
ward in company with one or both 
parents who remain with the patient 
until he or she is removed to the op- 
erating room under sedation, usually 
asleep. Except in most unusual cir- 
cumstances the patient is well enough 
to be discharged home the following 
day. This method of handling chil- 
dren for T. & A. has been used here 
for the past 25 years and may be said 
to have stood the test of time. It has 
several points, unrelated to cost, which 
appeal strongly to parents. Among 
these may be mentioned that admission 
occurs at a stated time on the day of 
operation, the parents are encouraged 
to stay with the child until removal to 
the operating room, while on the ward 
they meet the nurses and doctors who 
give postoperative care and see the 
kindly and efficient manner in which 
the children are treated. As a result 
many parents express their apprecia- 
tion directly or by letter for the high 



quality of care received, while com- 
plaints are few and far between. It is 
hoped that some solution to the 
economic and nursing problem can be 
arrived at which will permit us to con- 
tinue to handle these patients as we 
do now. 

Advances in middle ear surgery 
during the past five years or so have 
enabled us to salvage the hearing func- 
tion and repair certain defects in this 
area which previously could not be 
helped at all, or which had to be 
treated by obliterative procedures. 
Many perforated eardrums can now 
be closed, in certain patients, by the 
use of vein grafts or very thin skin 
grafts, usually with improvement in 
hearing. In some patients with chronic 
mastoid disease and destruction of the 
eardrum, removal of the diseased 
bone and other tissues followed by 
skin grafting can result in a "dry" ear 
and sometimes a substantial improve- 
ment in hearing. Much of this work 
has to be carried out while the surgeon 
observes through an operating micro- 
scope which magnifies from 6 to 40 
diameters. Our microscope, donated 
to us by the Women's Committee four 
years ago, has been put to good use 
and will undoubtedly be even more 
widely used in the future as new tech- 
niques are evolved. 

Our affiliated Resident Training 
Program with the Massachusetts Eye 
and Ear Infirmary has worked out very 
well over the past three years and 
should continue to provide a period of 
concentrated experience in children's 
otolaryngology for the Eye and Ear 
Residents in their third year of spe- 
cialty training. Each resident spends 
three months with us and is kept busy 
with out-patient work, operating, staff 
consultations, and other hospital ac- 
tivities. The advantages to the hospi- 
tal of staff coverage by a young man 
with a training background of at least 



114 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



two years in a specialty are too evi- 
dent to need amplification. Continua- 
tion of this relationship should be 
encouraged in every way. Much of the 
work of the resident is carried out in 
the out-patient department and one of 
our pressing needs is better out-patient 
facilities so that more than one doctor 
at a time has a place in which to ex- 
amine patients. Some of our patients 
have to wait two or three hours to be 
seen. At the present time the out- 
patient clinic is a one-man operation. 

The Otolaryngology Department 
exists as a separate unit with its own 
operating suite and ward (Division 
14) housed in Building A some dis- 
tance from the other clinical services. 
The ward and operating facilities are 
used almost exclusively by this service 
with the exception of an occasional 
eye patient. While this physical setup 
has obvious merits it also has serious 
drawbacks not the least of which is 
the expense of maintaining and staff- 
ing the area, particularly the operating 
suite. In future planning for the clini- 
cal services serious thought should be 
given to the integration of the Oto- 
laryngology Department with the 
other services dealing with the medi- 
cal and surgical problems of children, 
if any significant improvement in the 
cost of this operation is to be attained. 

HEARING AND SPEECH CLINIC 

Under the direction of Adam J. Sor- 
tini, Ed.D., this clinic has increased in 
size and importance, year by year, 
since 1952 when it was started with a 
staff of one, to I960 when it had a 
staff of fourteen and 10,766 patient 
visits. Among other distinctions, it 
has the highest patient load of any 
clinic of its kind devoted to children 
in the world (with the possible ex- 
ception of Russia). An important 
affiliated unit of this clinic, The Sarah 
Fuller Foundation, is primarily con- 



cerned with the teaching of pre-school 
deaf children. At the present time this 
unit has a staff of three teachers of the 
deaf and a social worker in addition to 
the part-time services of a psycholo- 
gist. This group is currently engaged 
in teaching 45 or more severely deaf- 
ened pre-school children who are able 
to hear, if at all, only with the help 
of a powerful hearing aid. Patients 
come to this clinic not only from New 
England but from all over the United 
States and Canada. We have also had 
patients from as far away as Greece 
and Iran for diagnostic study. Part of 
the clinic is housed on the opposite 
side of Longwood Avenue from the 
hospital and part of it on the third 
floor of the Administration Building. 
In neither place are the facilities or 
space adequate for the job we are 
called upon to do and here again our 
patients must wait, sometimes a mat- 
ter of weeks, to be seen. 

Carlyle G. Flake, M.D. 
Otolaryngologist-in - Chief 



115 



DEPARTMENT OF DENTISTRY 



DEPARTMENT OF 
DENTISTRY 



The activities of the Department of 
Dentistry have continued to expand 
and diversify since my last report. The 
demand for clinical care of patients 
who need the special facilities pro- 
vided in our Hospital or who are the 
responsibility of the Hospital con- 
tinues at a high level. Thus we have 
had an abundance of clinical teaching 
material at all levels of training, but 
time available to the permanent staff 
for individual research efforts has been 
less than optimum. 

Despite the heavy patient load, 
the Department has contributed sig- 
nificantly to the teaching program at 
the Harvard School of Dental Medi- 
cine. In addition to being responsible 
for the undergraduate teaching of 
pedodontics and orthodontics at the 
School, our permanent staff members 
were sponsors for no less than four 
undergraduate research projects this 
year in a class of thirteen students. 
One graduate student completed his 
three-year postdoctoral fellowship in 
June, I960, having received his clini- 
cal training in orthodontics in our De- 
partment. Two new students were 
enrolled in September. 

The Department, in addition to 
giving numerous lectures and clinics, 
figured prominently in the affairs of 
the Massachusetts Dental Society this 
past year. Three members of our staff 
served as chairmen of the Educational 
Program in January, and the pedodon- 
tic and orthodontic sections of the 
State meeting in May. 

Having two interns in pedodon- 
tics has strengthened the service and 
their training appreciably. The house 
officers find themselves less harassed 
and have more time for study and 
mutual exchange of ideas and clinical 
experiences. 

This summer a Panorex X-ray 
unit was installed in our Department, 
one of twenty-five such units available 



in the country. This machine makes it 
possible to produce an image of all the 
teeth on a single film. We have ex- 
plored the research possibilities of the 
technique, and a report on its applica- 
tion is in preparation. These X-rays 
are particularly helpful for delineation 
of gross lesions and have been of serv- 
ice to many departments of the Hos- 
pital. 

A new accounting system has 
been set up for the Department 
through the cooperation of Mr. Held. 
We are hopeful that the financial 
status of the Department will show a 
justification for a moderate increase 
in salaries for non-professional per- 
sonnel. At the present time we have 
two positions open that we have been 
unable to fill at the current wage scale. 

In 1961, our research manpower 
will be strengthened by a capable 
young man whose knowledge of 
salivary chemistry and nutrition is al- 
ready well documented. He will di- 
vide his time between the Hospital 
and the Harvard School of Dental 
Medicine, where he will also continue 
his research with Dr. James H. Shaw, 
Associate Professor of Biochemistry. 

Although our quarters can no 
longer be called strictly new, I con- 
sider them new and am pleased to re- 
port that they are and have been kept 
in excellent condition by the Main- 
tenance and Housekeeping Depart- 
ments responsible. 

Paul K. Losch, D.D.S. 
Dentist-in-Chief 



116 



REPORTS OF CHIEFS OF THE MEDICAL SERVICES 



OPHTHALMOLOGY 
DEPARTMENT 



The Ophthalmology Department has 
continued to provide consultation 
service to all units of The Children's 
Hospital Medical Center, including the 
Children's Cancer Research Founda- 
tion, The House of the Good Samari- 
tan, and the Children's Mission to 
Children, etc. With Dr. Harry Shwach- 
man's cooperation, the Department is 
carrying out an ophthalmologic survey 
of patients with cystic fibrosis. The 
Department is also participating in a 
study relating to congenital anomalies. 
While no actual tally of the number of 
consultations has been kept, they aver- 
age about three per week, but vary 
from none to seven per week. The 
Department could probably function 
more effectively if it were provided 
with some sort of examining room, 
were it ever so humble. We look for- 
ward to the possibility of having a 
Fellow in Ophthalmology in residence 
and beyond this to the eventual re- 
establishment of the Eye Clinic. 

Trygve Gunderson, M.D. 

Ophtbalmologist-in-Chiej 



Bibliography 

Gundersen, T., Cornea and sclera: in- 
juries and diseases. In Traumatic 
Medicine and Surgery for the At- 
torney, VoL 4. Butterworth. (In 
press.) 

, Surgical treatment of bullous 

keratopathy. Arch. Ophthalmol., 64: 
260, I960. 

and Liebman, S. D., Relation- 



ship to systemic disease. In Sanders, 
T. E. (Ed.), Pediatric Ophthalmol- 
ogy. Mosby. (In press.) 



117 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



The Changing Face of Administration 119 

Nursing Service and School of Nursing 121 

Social Service 127 

Out-Patient 129 

Medical Records 132 

Patient Education and Recreation 134 

Physical Therapy 13 5 

Personnel 137 

Volunteer Service 138 

Dietary 139 

Purchasing 140 

Visual Education 141 

Pharmacy 142 

Special Services 143 

Communications 143 

Employee Health Service 144 

Maintenance 145 

Surgical Appliance Shop 146 

Housekeeping 147 

Print Shop 147 



119 



THE CHANGING FACE OF ADMINISTRATION 



The administrative departments underwent the following changes 
in 1960: 

Mr. Greer Williams in March succeeded Mr. A. William Smith, 
Director of Resources, but, as Assistant Director in charge of develop- 
ment and public relations, Mr. Williams acquired the additional responsi- 
bilities of supervising and coordinating the Departments of Fund Rais- 
ing and Public Information. 

Mr. Smith remained with the Hospital to spearhead the organi- 
zation of the Cooperative Hospital Laundry, an enterprise which he 
initiated to provide laundry services for at least five major hospitals. 

Mrs. Harriet H. Gibney in June became Director of Public Infor- 
mation, succeeding Mrs. Shirley Van Cleef, who resigned. 

Mr. John Glancy in June became Director of the Surgical Brace 
and Appliance Shop, succeeding Mr. Edward Roberts, who retired. 

Mr. Richard E. Held became Comptroller in August, succeeding 
Mr. Edward S. Lancaster, who retired. 

Mr. Alexander T. Brown became Director of Personnel in October, 
succeeding Miss Adeline Morrill, who retired. 

Mr. George D. Nicoll, for ten years carpenter foreman, in October 
became Director of an entirely new department, Special Services. 

Miss Marion W. Hall, Director of Social Services, retired in October 
after twenty years of service. Her final report appears elsewhere in 
this document. She died on March 24, 1961. 



121 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



NURSING SERVICE AND 
SCHOOL OF NURSING 



NURSING SERVICE 

There are features of hospital nursing 
services which are not common to all 
enterprises and which make for diffi- 
culties in planning and operation. 

One feature is that the nature and 
extent of the task to be done is un- 
predictable and never under the con- 
trol of those charged with the respon- 
sibility to carry it out. Another is that 
the task must be carried on seven days 
a week, twenty-four hours a day. These 
facts are so obvious that they tend to 
be taken for granted, yet they under- 
lie the gravest problems with which 
the nursing department must attempt 
to cope. That these characteristics are 
not unique to nursing is also true, for 
other departments face the same prob- 
lems though in a lesser degree. 

Unpredictability stems not only 
from the emergency nature of much 
hospital work but also results from 
other causes not as readily apparent. 
For example, patient population rises 
and falls as illness in the community 
increases or declines; it is likely to be 
low during the holiday periods and 
high in the early summer when much 
elective surgery is to be done. Some 
of these can be anticipated with a cer- 
tain assurance although patterns 
change from year to year. More irreg- 
ular are the individual plans of mem- 
bers of the medical staff; a week-long 
meeting of surgeons or pediatricians 
may alter the work load markedly as 
also may the fact that a large number 
of physicians take their vacations at 
the same time. 

As a consequence the work load 
is unevenly distributed with quite a 
considerable range between the low 
and the high. In 1959-60 for example 
the monthly average of patients showed 
a low of 230 in December and Sep- 
tember and a high of 285 in June, or 
an increase of fifty-five patients on 
the average in the latter month, almost 



25 per cent more than in the other 
two. Similarly operations ranged from 
398 in September to 577 in June, an 
increase of nearly 45 per cent. 

Such deviations pose a crucial 
question: does one attempt to staff for 
the peaks or try to strike an average? 
The problem remains even if a group 
of temporary workers could be drawn 
upon to meet a sudden need. This is 
unlikely to be the case at any time 
for most nurses who work desire regu- 
lar employment; others who might be 
available as temporary auxiliary work- 
ers require too much training to be 
useful on a short term basis. 

An unfortunate aspect of these 
variations, even when they can be 
anticipated, is the inability of the 
nursing service to relate work load to 
availability of staff. For example, 
peaks in June or July are extraordinar- 
ily difficult to meet since many nurses 
leave the staff in the early summer 
and vacations must be given during 
this time. Thus there are likely to be 
periods when nursing cannot provide 
enough care for patients, employees 
work overtime and many frustrations 
develop. 

It is probable that there is no 
complete remedy for the situation 
since so many different factors and 
people are involved: it is possible 
however that joint planning and more 
exchange of information might miti- 
gate some of the worst aspects. 

The twenty-four-hour nature of 
the job presents the nursing staff with 
other serious problems. In these days 
of plentiful employment opportunities 
it is most difficult to find persons who 
are willing to work weekends and 
nights. These periods are not popular 
with any but a small proportion of 
the population; they are intensely dis- 
liked by most young women, the group 
upon which nursing services must 
rely for the most part. Intense pres- 



122 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



sure upon employees to work at these 
times tends to result in absenteeism 
or even withdrawal from the job. 
While resistance to working at these 
hours has been increasing, the need 
for staff at such times has mounted 
rapidly. More emergency and late ad- 
missions, more work done by residents 
during the evening hours, a higher 
proportion of critically ill patients and 
a decline in availability of student 
nurses have all combined to produce 
this need. 

While nursing service does not 
control the scope of the task which it 
must do, it has the added problem of 
being dependent to a great extent 
upon supporting services from other 
departments, departments over which 
it has (and should have) no jurisdic- 
tion. In too many instances nursing 
is responsible for work which might 
better be done by these departments 
or is obliged during night and week- 
end hours to take on jobs which are 
done elsewhere during weekdays. This 
may be because the work load is too 
small to warrant twenty-four-hour 
coverage in the other department or 
it may result from another depart- 
ment's difficulty in obtaining staff at 
these awkward times. Whatever the 
reason, the result often is added work 
for nursing service which must always 
be at hand to meet its commitment 
as best it may. Examples of this pe- 
culiar situation, both in this hospital 
and in others, are too obvious and 
frequent to need to be cited. 

Lest these comments be inter- 
preted as indicating a wish to unload 
work onto other hospital departments 
perhaps a word of explanation is in 
order. There is an historical back- 
ground for the situation which per- 
sists to some extent in this institution 
today and was common to all hospitals 
until recently. 

Because nursing at one time was 



responsible for many of the activities 
now allocated to dietary, housekeep- 
ing, laundry, etc., it had a difficult 
time to get transferred to these new 
departments many of the responsibili- 
ties which are appropriate to them. 
And because nursing was always here 
at night, it was never able to relin- 
quish some tasks which properly are 
not nursing at all. 

Aside from the fact that much 
of the work referred to is more ap- 
propriate to another department, it is 
also obvious that it is costly to use 
the time of registered nurses to do 
jobs for which little training is re- 
quired and which can be done in 
many instances by a person whose 
wages are less. Fortunately many 
gains have been made in regard to 
this problem; doubtless more will be 
as time goes on. 

In recent years change appears 
to be the only constant in hospitals; 
change affects nursing in a number 
of ways. One of these is the develop- 
ment of new methods of treatment 
which require new learning for the 
nurse; as the physician introduces new 
therapies, he sometimes turns over to 
the nurse responsibilities which he 
formerly assumed. A good example is 
the administration of medication by 
the intravenous route, a procedure 
formerly done by the residents, now 
the responsibility of the graduate 
nurses. This change alone, adopted in 
1959, has created a need for more 
nurses as the increasing use of the 
method consumes many hours of their 
time each day. 

Another change, evident in the 
past decade in particular, is the short 
stay of most patients. This trend, so 
advantageous to the patients, has posed 
considerable problems for the hospital 
and affects many departments. In 
nursing it has a tendency to make 
management of the division more 



complicated for paper work multiplies 
and supervision of patient care is dif- 
ficult when there are so many new 
children each day. Doubtless it con- 
tributes, too, to the nurse's lack of 
satisfaction in her job as she becomes 
less acquainted with her patients and 
less able to feel joy and pride in the 
piogress of children well known to 
her. 

Finally, changes in personnel 
make stabilization of the service ex- 
ceedingly difficult; orientation and 
training programs help but they can- 
not entirely substitute for longer em- 
ployment and the familiarity with de- 
partmental needs which comes from 
experience. The operating room pro- 
vides an excellent example; there it 
has been accepted that the first six 
months of a nurse's employment is 
largely orientation; if she leaves at 
the end of the first year the productive 
period is very brief. 

Changes in staff have been a 
serious problem during the year as 
they have been in the past. Figures 
which show a high rate of turnover 
quite properly give rise to concern, 
yet such figures can be most mislead- 
ing if not examined with care. 

During the past year ninety-five 
graduate nurses were newly employed 
and ninety-seven terminated; these 
numbers represent more than half the 
total number of such persons usually 
employed. 

Analysis of the ninety-seven 
shows the following, however: four- 
teen persons came for specified tem- 
porary employment; twelve were 
foreign nurses under the exchange 
visitor program in which the usual 
plan is for a six-month experience. 
If these are excluded from the total 
we find that the turnover figure is 48 
per cent, still high but slightly lower 
than in 1958-59. Moreover, of the 
entire group we find that approxi- 



123 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



mately two-thirds left because of com- 
pelling personal circumstances. The 
balance is twenty-two persons, or 31 
per cent of the total who left this in- 
stitution, who went to other positions. 
Three of these had been employed 
less than a year; the average length 
of stay for the twenty-two was two 
years; six had been here for three or 
more years. 

If these twenty-two registered 
nurses who left the staff for unknown 
reasons, perhaps including dissatisfac- 
tion, represent the true turnover then 
the percentage is 12.4 per cent — con- 
siderably lower than that given above. 
Yet this analysis affords little com- 
fort for it becomes clear that relatively 
little can be done to alter the rapid 
change in staff; more effective ways 
to carry on nursing service under such 
conditions should be the primary ob- 
jective. 

Turning to the other groups in 
nursing service, the aides, orderlies 
and clerks, one finds a different picture 
and one in need of vigorous methods 
to bring about improvement. 

Here we find that well over 100 
persons came and went during 1959- 
60. Approximately one-fifth were 
summer employees but exclusive of 
this temporary group the turnover 
figures are as follows: aides, 77 per 
cent; orderlies 100 per cent; clerks 
138 per cent. These are much higher 
than for the previous year, in some 
cases nearly double, and unquestion- 
ably reflect job dissatisfaction. 

Figures do not show to what ex- 
tent personal reasons contributed to 
termination but in many instances 
this doubtless was a factor. Yet it 
appears probable that the chief ele- 
ment has been the wage scale which, 
until the new rates became effective 
October 1, I960, had not been in- 
creased since the spring of 1957. Un- 
til the new scale has been in effect 



for a few months it will be difficult 
to determine whether or not other fac- 
tors also play a large part in this dis- 
tressing state of affairs. 

Terminal interviews conducted by 
the personnel department might be 
helpful in such an analysis. It is im- 
perative that this situation be im- 
proved if nursing service is to ap- 
proach a satisfactory equilibrium and 
the expense of turnover to be reduced. 
Unfortunately it is not known what 
the actual cost of hiring and training 
a new employee may be; it is known 
that industry considers high turnover 
a dangerously expensive matter. 

The auxiliary worker is of im- 
portance to nursing service as she 
should assume duties for which she 
is prepared and thus assist the regis- 
tered nurses who always are in short 
supply. Moreover, as educational pro- 
grams for student nurses increasingly 
reduce the students' availability, the 
auxiliary workers become essential to 
fill part of the gap. 

Another group, the licensed prac- 
tical nurses, is playing an increasingly 
important role in patient care; it is 
pleasant to report that we employed 
last year more of these nurses than at 
any time in the past. While the num- 
ber remains relatively small and is less 
than half that felt to be needed, there 
is now reasonable hope that the de- 
sired number may eventually be se- 
cured. 

Efforts at reorganization of the 
service, begun several years ago, in 
order to involve more members in the 
work of the entire department and 
in improvement of patient care as 
well as to bring groups with common 
interests together to study and attempt 
to solve their problems, have begun to 
bear fruit. Committees working on 
procedures, records and educational 
and training programs have been ac- 
tive and productive. Unfortunately 



committee work takes time but it is 
only through such groups that much 
of the work of a large and diversified 
department can be accomplished. 

Mrs. Marion Stewart joined the 
education department of the nursing 
service as instructor of auxiliary work- 
ers. For much of the year she was 
obliged to supervise the House of the 
Good Samaritan but with the appoint- 
ment during the summer of Miss Mar- 
garet Francis as supervisor on the 
convalescent divisions and the res- 
pirator unit, Mrs. Stewart was freed 
to give more time to her task of train- 
ing and will in the coming year be 
able to develop this program better to 
meet current needs. 

All the changes in personnel men- 
tioned earlier place a great responsi- 
bility on the education department. 
There are three persons at present; a 
fourth has been requested for the com- 
ing year to have as her principal re- 
sponsibility the instruction of nurses 
in the care of patients having cardio- 
vascular surgery. 

In addition to a continuing pro- 
gram of instruction this department 
assumes responsibility for early orien- 
tation of new staff members and ar- 
rangements for the many visitors who 
come to the hospital. The number of 
new nurses employed in I960 gives 
an indication of the size of the task; 
visitors too continue to increase in 
number so that last year the depart- 
ment made plans for and met with 
seventy-two persons or groups. 

Miss Francis, now supervisor in 
the House of the Good Samaritan, 
previously was assistant to the ortho- 
pedic supervisor, Miss Gassman, and 
thus comes to the new position pos- 
sessing a familiarity with the respi- 
rator unit which is exceedingly helpful. 

Miss Jeanne Colt, surgical super- 
visor, was on leave of absence for 
study throughout the year, returning 



124 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



early in September. Mrs. Ann Lenni- 
han came from the Out-Patient De- 
partment to assume Miss Colt's super- 
visory duties temporarily. She has now- 
returned to the Out-Patient Depart- 
ment as assistant supervisor. 

During the summer of I960, staff 
vacancies necessitated the closing of 
the Medical Emergency Clinic during 
the evenings. Until the fall of 1958 
one emergency clinic, surgical, had 
cared for all patients during evening 
hours. In that year the second clinic 
was opened because of the increase 
in emergency visits which totaled 
about 700 between 1957 and 1958. 
Between 1958 and I960 a phenome- 
nal rise of 5,700 in such visits occurred, 
most of them in the evening hours, 
hence the closure of one evening 
clinic caused a serious situation. 

Not many years ago the nature 
of the emergency service was such 
that nurses with relatively little ex- 
perience in the department would 
meet the situation if necessary; today 
this is no longer true and the nurses 
who assume this responsibility must 
have a considerable period of indoc- 
trination. When a number of persons 
left the staff during the summer there 
were not enough qualified persons 
available for these hours. 

Staffing the two clinics is costly 
for the hospital but with the present 
physical arrangements no other solu- 
tion is possible. With sufficient space 
suitably planned to meet the needs 
of all emergency patients one clinic 
should meet the need effectively and 
at less cost. 

The operating room is another 
department in which experience of 
staff is of the greatest importance; 
v/hen vacancies occur the replacement 
must often be by a nurse without suf- 
ficient experience to permit her to 
carry a full share of responsibility. 
Resignations in the spring, therefore, 



presage difficulty in the ensuing 
months when work load is high and 
staff must have vacation. 

The number of operations in I960 
exceeded slightly the total for recent 
years; the total is, however, of less sig- 
nificance than the nature of the sur- 
gery and the fluctuations in work load 
from month to month or even from 
day to day. 

Day-to-day planning has been im- 
proved this past year by an arrange- 
ment which gives the supervisor more 
responsibility for scheduling opera- 
tions and by cooperation between the 
Admitting Department and the Op- 
erating Room in the bookings. 

The additional space alloted to 
Central Supply this year, as a conse- 
quence of the closing of the old Blood 
Bank, has been of great value. It will 
not be used to the best advantage, 
however, until certain structural 
changes have been made; the plan for 
these is dependent to some extent 
upon the decision to be made regard- 
ing purchase of solutions for intra- 
venous therapy. 

The hospital has been fortunate 
to have had senior supervisors on the 
evening and night service who have 
held those positions for a long time. 
Not only are the hours difficult ones 
but the responsibilities which these 
persons must assume are onerous so 
that suitable nurses are not easy to 
find. The less experienced assistant 
supervisors have changed more fre- 
quently; this year a number of appoint- 
ments were made: Mrs. Ann Hoist 
Clark became assistant evening super- 
visor; Miss Jacqueline Patterson was 
appointed night assistant supervisor; 
Miss Joan Bodman, formerly employed 
as an assistant head nurse, returned to 
the evening service. 

It is not possible to mention in- 
dividually the many persons whose 
services to the hospital were termi- 



nated, nor the many new appoint- 
ments which have been made. The 
many devoted persons who have been 
unstinting in their efforts to give good 
care to children, all deserve high 
praise. 

The department has been involved 
in two new projects this year, both 
interesting and both time-consuming. 
The first is a study of the cost of run- 
ning the School of Nursing, a study 
which is part of a nation-wide project 
of the National League for Nursing. 
This is of course primarily a school 
undertaking but all head nurses and 
supervisors in departments to which 
students are assigned have had a part 
as well. Secondly, the new cost ac- 
counting system and the new methods 
of budgeting instituted at the begin- 
ning of the year have taken time of 
members of the supervisory and ad- 
ministrative staff. The knowledge 
gained from this experience, however, 
has been of value in developing in- 
creasing awareness of the expense of 
each unit. 

The department has reason to be 
grateful to the Volunteer Department 
for the help rendered, especially dur- 
ing the day in transportation of pa- 
tients. Evening volunteers, while less 
numerous than last year, have given 
about 2,000 hours to the care of pa- 
tients. 

Attached to this report is a sum- 
mary of the number of employees 
requested for the department in the 
1961 budget. 



AUTHORIZED POSITIONS 




Budget Requests 1961 




PROFESSIONAL NURSES 




Director 


Vi 


Associate Director 


Vi 


Assistant Directors 


Wi 


Supervisors 


10 


Asst. Supervisors 


6 


Head Nurses 


28 



125 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



Assr. Head Nurses 21 

Staff Nurses 137 

Director, Education 1 

Instructors 2Vi 210 

LICENSED PRACTICAL NURSES 49 
AUXILIARY WORKERS 

Aides 93 Vi 

Orderlies 15Vi 

Div. Clerks 18Vi 
Ward Manager 2 129^2 

SECRETARIAL AND CLERICAL 

Secretaries 2 

Clerk-typist 3 
Clerk Vi 5Vi 

Total ~~ 394 

SCHOOL OF NURSING 
In September a new class of forty-five 
students of nursing entered the school; 
of these thirty-three live in Massachu- 
sets, nine come from the other New 
England states, and one each from New 
Jersey, North Carolina and Ohio. 

The Admissions Committee con- 
tinues to select the class from approxi- 
mately 200 applications, of which 
some are from individuals who have 
applied to more than one school and 
may not have this as the first choice. 
Last year the committee reviewed 187 
records; approximately the same num- 
ber of individuals were interviewed 
and taken around the hospital and 
Gardner House. 

The institution of an application 
fee in 1959 seems not to have altered 
significantly the number of applica- 
tions filed, except to reduce the num- 
ber received from persons not serious 
about entering the school; the num- 
ber of incomplete applications 
dropped from about sixty in 1958 to 
sixteen in I960. Since the processing 
of applications is a time-consuming 
and costly task, this reduction is most 
welcome. 

The committee has been accept- 



ing approximately three students for 
each two who enter the school; in 
other words, one in three changes her 
plans after filing application. 

At the close of the year I960, 
the school of nursing was smaller than 
at the same time last year due to a 
higher withdrawal rate than is usual. 
Most of the students left because they 
were not successful in passing the 
courses in the first year. 

There were thirty- two members 
in the graduating class, for whom ex- 
ercises were held at the Temple Israel 
on September 18. The speaker on this 
occasion was Dr. Ernest Caverly, Su- 
perintendent of Schools in Brookline. 

Fourteen of the thirty-two joined 
the staff at the hospital, a somewhat 
lower number than in most years. At 
least seven of the graduates had plans 
to marry and to live elsewhere than 
in Boston. 

Two members of The Children's 
Hospital faculty are on leave of ab- 
sence this year for study. One of these 
is the instructor in orthopedic nursing, 
Miss Ann Noon, whom it has not been 
possible to replace; the other, Miss 
Margaret Heafey, is away for one 
semester. The vacancy created by the 
resignation of the instructor in public 
health nursing in June has not as yet 
been filled. Miss Phyllis Diegoli, in- 
structor in surgical nursing, left the 
staff in order to do graduate study. 

The following faculty members 
have been appointed: Miss Jean 
Crocker, The Children's Hospital 
School of Nursing, teaching assistant; 
Miss Carmel DiNicolantonio, St. Eliza- 
beth's Hospital School of Nursing, 
Youngstown, Ohio, and B.S., St. Louis 
University, instructor in surgical nurs- 
ing ; Miss Joan Grindley, Catherine 
Laboure School of Nursing and B.S., 
Boston College School of Nursing, 
junior instructor in fundamentals of 
nursing. 



At the annual meeting in 1959 the 
Women's Committee voted to give ap- 
proximately $1,200.00 for the Scholar- 
ship Fund, thus increasing that fund to 
a total of $5,333.20 The Alumnae As- 
sociation of the School of Nursing 
also contributes a sizable sum each 
year for scholarships. 

During the past year eleven 
scholarships have been awarded; these 
usually are for $100.00. 

The Alumnae Association also 
sent a student to the National Conven- 
tion of the Student Nurses' Associa- 
tion in the spring of I960. 

Following the reorganization of 
the Medical Center and the adoption 
of the new name, there was discussion 
in the Faculty and in the School of 
Nursing Committee about the name of 
the school. Thus far no change has 
been made, and the school continues 
under its old title until a decision is 
reached by the Board of Trustees. 

Affiliate Program 

There have been faculty changes 
in the affiliate program. Miss Amy 
Nurse, the chairman, resigned at the 
close of the year because of illness. 
No appointment has been made of a 
new chairman. Miss Diana Misenti, 
one of the instructors in the program, 
is on leave of absence during 1960-61 
for study. Mrs. Margaret Crooker and 
Miss Patricia Walsh also left the staff 
during the year. 

Three new appointments have 
been made to this program: Miss Rita 
Bryant, Boston City Hospital School 
of Nursing and M.S., Boston College; 
Miss Nancy Parker, The Children's 
Hospital School of Nursing and B.S., 
Boston University, and Miss Helene 
Marsh, B.S., Boston College School of 
Nursing. 

There are nineteen affiliated 
schools, all but two of which send stu- 
dents throughout the year. The school 



126 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



was notified in the spring that the 
Roger Williams General Hospital 
School of Nursing in Providence, 
Rhode Island, wished to terminate the 
affiliation in Ocotober because it was 
ready to present a program in pedi- 
atric nursing in the home school. 

This withdrawal of a school of 
moderate size reduces slightly the 
number of students entering here but 
it is rather unlikely that an application 
from another school will be accepted 
immediately since the number of stu- 
dents in the last several years has 
seemed to be larger than desirable in 
relation to the facilities, housing and 
available faculty. 

In 1959-60 the total number of 
students entering the program was 
587. Plans for 1960-61 are for 522 
students. 

In the fall of 1961, the total num- 
ber of days of evening and night duty 
will be reduced five per student in the 
twelve-week period. Also contem- 
plated in the near future is a change 
in instruction in formula preparation. 
The Approving Authority for Schools 
of Nursing has given tentative ap- 
proval to a plan which will eliminate 
the present requirement that students 
spend two days preparing formulas 
for infants. Other instruction and ex- 
perience will be substituted. 

College Program 

Miss Leona Stapleton, one of the in- 
structors in the program for these stu- 
dents, transferred to the nursing serv- 
ice as a head nurse early in I960. She 
was replaced by Miss Marie Cullinane, 
a graduate of Boston College School 
of Nursing, and M.S., Catholic Uni- 
versity in Washington. 

During the year seventy-seven 
students have come from the colleges 
to complete the twelve-week experi- 
ence. 

Miss Mary Young, the librarian, 



resigned in the early summer; fortu- 
nately, it was possible to appoint in 
her place Miss Jutta Luhde, a gradu- 
ate of the Simmons College School of 
Library Science. Miss Luhde is the 
first full-time librarian the school has 
had. 

In recent years the acute housing 
situation has been reported upon fre- 
quently; at times it was feared that the 
school would not be able to accommo- 
date all the students for whom ar- 
rangements had been made. During 
this year there has been an easing of 
this situation with an average of 208 
in residence. It is hoped that at some 
date not too far distance the two floors 
at 329 Longwood Avenue now oc- 
cupied by students may be reclaimed 
for staff housing. The arrangement at 
329 is not a satisfactory one since rela- 
tively few individuals are housed, 
most rooms are not single and the cost 
of maintaining a residence of this type 
is excessive. 

This year the school has become 
involved in a study of the cost of nurs- 
ing education which should provide 
very helpful information for the school 
and the hospital. The rising cost of 
education is of concern in all fields be- 
cause of the difficulty in finding funds. 
Hospital nursing schools are in a par- 
ticularly difficult situation since in- 
crease in cost of running the school is 
eventually reflected in charges to pa- 
tients. It is, therefore, cause for satis- 
faction that we may hope eventually 
to have some accurate figures which 
may be compared with similar studies 
done in as many as 200 schools of 
nursing throughout the country. This 
is a project of the National League for 
Nursing. 

The school has cause to be grate- 
ful to its many good friends, among 
whom should be mentioned the 
Women's Committee, the Alumnae 
Association of the School of Nursing, 



the members of the School of Nursing 
Committee and the many doctors and 
staff members who contribute to in- 
struction of students. 

Murial B. Vesey, R.N. 

Director of Nursing Service 

and School of Nursing 



127 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



SOCIAL SERVICE 



Introduction 

When a report is written yearly, the 
fear of repetition and staleness arises. 
This fear has been unfounded during 
the last decade or more of the tran- 
sitional years when the hospital has 
been growing and becoming unified 
into a Medical Center. There are al- 
ways new developments to present. 
Mention should be made this year of 
two in particular. 

First, this Social Service Depart- 
ment and the Children's Mission have 
become closer in their staff relation- 
ships and in unifying services to pa- 
tients. This has been the result of a 
joint effort on the part of both groups. 
Case conferences and mutual explora- 
tion of appropriate referrals were two 
means which contributed to this end. 

Secondly, the Social Service De- 
partment has been assigned the ad- 
ministration of several generous funds 
which had been contributed for spe- 
cial needs of individual patients. It 
has, therefore, been possible to help 
with such things as board and room 
for desperate out-of-town families, 
chair lifts for polio patients, and spe- 
cial schooling. 

Staff changes 

The usual "hail and farewell's" have 
been in evidence. In November, the 
long- vacant position in Neurology was 
filled by Miss Diane Livingston, who 
had graduated the previous year from 
Simmons College School of Social 
Work and who had spent a year in a 
Psychiatric Clinic in England. In 
January, Mrs. Ann Sheingold resigned 
from the Psychiatry Department to re- 
turn to private life. She was replaced 
by two half-time workers, Mrs. Fran- 
ces Lewis and Mrs. Louise Lown, both 
with previous experience. In June, 
Mr. Andrew Johnston resigned from 
the Respirator Unit to take a position 
in a Rehabilitation Unit in Water- 



ville, Maine. Also, Mrs. Nancy Norton 
in Psychiatry resigned to accompany 
her husband to the West Coast. At 
the end of July, Mrs. Evelyn Silver- 
man, who had been working a day and 
a half in Psychiatry, retired to private 
life. In August, Miss Suzanne Fleisch- 
ner resigned from the Orthopedic 
Service for advanced education in Pub- 
lic Health. Miss Anne Turner from 
the Simmons College School of So- 
cial Work replaced her. Also, in 
August, Mrs. Janet Mayer resigned 
from the Medical In-Patient Service to 
enter private life. She was replaced by 
Mrs. Jane Scease who had just gradu- 
ated from the Simmons College of 
Social Work. In September, Mrs. 
Virginia (Rugh) Wade resigned from 
the Polio Service to accompany her 
husband to Cleveland. She was re- 
placed by Miss Mary Lou Weaver who 
had just received her Master's Degree 
from the University of Pittsburgh 
School of Social Work. In September, 
Mrs. Phyllis Haberstroh, a recent grad- 
uate of Simmons College School of 
Social Work with some previous ex- 
perience in Canada, came to the Psy- 
chiatric Clinic to replace Mrs. Norton. 

Teaching 

The course to student nurses was 
again given in June by Mrs. Ruth 
Cowin and the Director. Two students 
were placed in Psychiatry, one from 
Boston University School of Social 
Work and one from Simmons College 
School of Social Work, under the 
supervision of Miss Walsh and Miss 
Anderson. A third student was placed 
in the Medical Division under the 
supervision of Mrs. Ruth Cowin. 

The Social Work Careers Pro- 
gram again sent us a college student 
for eight weeks during the summer, 
supervised by Mrs. Evelyn Roll and 
working primarily on the Orthopedic 
Service. The Social Service Depart- 



128 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



merit contributes its share of time to 
giving lectures, being on panels, and 
other community teaching. 

Staff Education and Opportunities 

Dr. Benaron continued his psychiatric 
group consultation every other week 
for the medical workers. A staff com- 
mittee has been considering ways of 
furthering staff education and stimula- 
tion within the group. Attendance at 
out-of-town conferences and further 
formal education has been curtailed 
by lack of funds, although the hospital 
has been generous in allowing time. 

Direct Service to Patients 

The Social Service Department has 
had major or minor interest in 4,606 
patients during the year. Through our 
camp program we sent 105 children 
for 459 Vi weeks, carefully selected be- 
cause their physical or emotional needs 
seemed to warrant such an experience. 

We have been increasingly con- 
cerned with the number of children 
coming to our attention either because 
of demonstrated neglect or abuse, or 
where such is suspected but difficult to 
prove. We have worked closely with 
the doctors and the Society for the 
Prevention of Cruelty to Children on 
these cases and are now collecting 
them for study, to see if future han- 
dling can be improved. 

Of course, the Social Service De- 
partment deals with many patients and 
families and distances, including a 
variety of foreign countries. Knowl- 
edge of foreign languages, ways of 
communicating with distant com- 
munities, and arrangements for appro- 
priate temporary living in Boston have 
been additional facets to the ordinary 
social problems. Facilities near the 
hospital which will accommodate chil- 
dren and allow cooking have become 
increasingly more difficult to find. 



Staff Needs 

Request for additional members of the 
Social Service staff assigned to the 
Adolescent and Metabolic Units was 
made by Dr. Gallagher and Dr. Crigler. 
Lack of funds has prevented these 
additions. Another psychiatric worker 
has been requested this fall because of 
the increased psychological and psy- 
chiatric staff. A worker for the Surgi- 
cal Service has been authorized, but 
not yet found. 

Adjustments and Hopes 

With the relatively large staff of 
twenty-eight members, widely dis- 
tributed physically, working in some- 
what self-contained units and in some 
instances paid through special funds, 
it is difficult to maintain integration, 
cohesiveness and solidarity for the 
whole department. Adjustment to the 
continuous growth of the Social Serv- 
ice Department has been a yearly 
necessity since 1947 when the first 
new social worker was added to the 
Seizure Unit. This growth from seven 
to the current number has made us 
one of the largest departments in the 
Boston hospital community. We are 
now big and we feel it. Nevertheless, 
the unity of the Social Service Depart- 
ment has been maintained. The desire 
and effort of each individual member 
to be a part of the whole has been the 
greatest welder, and has been the basis 
of its esprit de corps during the last 
year. 

It is a pleasant custom at the end 
of a report such as this to thank those 
with whom we have been associated in 
the year's work. At this time, I should 
like to concentrate on expressing our 
appreciation to Mr. Greer for his inter- 
est in the department since his arrival, 



and to Dr. Snedeker for the continued 
interest and help he has given over 
these many years. 

Marion W. Hall* 
Director of Social Service 



*Miss Hall died on March 24, 1961. 



129 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



OUT-PATIENT 



The Out-Patient Department as a 
whole has shown an increase within 
the last five years in the number of 
visits to the forty-one clinics that com- 
prise this department. Attendance in 
the three major clinics, however, has 
remained the same and in some in- 
stances a slight drop has been noted. 
This drop is offset in the overall figure 
by the increase in the Special Clinics 
including the Medical Emergency. 
Most of these clinics have reached 
their optimum capacity and in some 
instances have far exceeded their 
physical facility. 

In 1952 patients made 53,946 
visits to the Out-Patient Department. 
The following year the number jumped 
to 70,802. The average number of 
visits in the Out-Patient Department 
for the last five years is between 85,000 
and 87,000 per year. There have been 
two exceptional years. The highest 
figure recorded was in 1959: 97,667 
visits were made to the Out-Patient 
Department. The next greatest num- 
ber was 91,478 visits in 1956. 

In analyzing these figures, we find, 
the Psychiatry Department showed an 
increase in 1959 of about 5,000 visits 
over the previous year. In 1957 they 
moved to the east wing of "A" Build- 
ing and in this area were able to meet 
the need for a while. Presently the need 
has again outgrown this facility. The 
waiting list for appointment for treat- 
ment is now from four to six months. 

The Medical Emergency Clinic 
has increased at a startling rate. It is 
difficult to appreciate the "real" in- 
crease here because in September, 
1958, it was necessary to keep the 
clinic opened until 1 1 P.M., seven days 
a week, to accommodate the increase. 
The statistics were thrown off balance 
that year because the number seen 
after 4:30 P.M. formerly had been in- 
cluded in the Surgical Out-Patient 
statistics. 



The "real" increase may be 
realized in the last two years, with the 
hours and recording of statistics being 
the same. In 1959, 12,234 patients 
were treated. In I960, 14,216 patients 
were treated. This increase has been 
consistent for the last five years. Al- 
though improvements have been made 
such as supply cabinets and counters, 
the problem of sufficient space has not 
been solved. The space to maintain 
adequate emergency and isolation 
rooms as well as space for medical 
students and clinical fellows is urgently 
needed. Also provision for comfortable 
waiting space for parents is lacking. 

While the Medical Emergency 
Clinic is showing a steady increase, 
there appears to be a tendency for 
lower clinic attendance in the General 
Medical Clinic. The number of pa- 
tients seen in 1958 was 6,595; in 1959, 
6,694; in I960, 6,242. The number of 
"new" patients has shown a decrease 
also. In 1958 there were 2,761; in 
1959, 2,755 and in I960, 2,405. The 
waiting list for new appointments at 
present is one week. 

The following clinics have shown 
an increase in patients treated: 

1934 I960 

Psychiatry 2,204 9,422 

Division of 

Child Health 1,751 3,089 

Adolescent 4,393 5,766 

Allergy 3,216 4,432 

Cardiac 1,568 2,066 

A number of alterations in ad- 
ministrative procedure have been 
made, aimed at increased efficiency, 
reducing patient waiting, and increas- 
ing the number of patients who can 
be seen in the same time. These in- 
clude the introduction of an advance 
registration form to enable records to 
be made out in advance for new pa- 
tients so that they may be seen more 
promptly in the morning and the use 
of a preliminary history form which 



130 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



parents may fill out while waiting. 
This does not replace regular history 
taking by the physician but provides 
him with quicker answers to routine 
questions such as those concerning 
birth weight, siblings, immunizations, 
etc. Efforts have been made to stream- 
line the return of laboratory reports 
and to have the reports obtained by 
the clerks at the end of each afternoon 
and put with the records of those pa- 
tients scheduled to return the follow- 
ing morning. This has been difficult 
to do because of the difference in tim- 
ing between the return visit and re- 
turn of laboratory reports. 

To facilitate the identification of 
out-patients for charges an addresso- 
graph identification plate system was 
introduced in June, 1959. The plastic 
plate when used properly identifies 
the patients for billing primarily, but 
may also be used in the internal op- 
eration of the clinics. To date over 
23,000 plates have been issued. The 
great mobility of our patients makes it 
necessary to re-issue plates not in- 
frequently; this, combined with the 
lag in establishing the plate system 
throughout the entire out-patient de- 
partment, leaves much to be desired 
by the accounting department. In the 
major clinics where the plate system 
is well established there is evidence of 
improvement in patient identification 
and acceptance of the professional 
staff of the plate as a time-saver in 
making out requisitions and forms. 

The Out-Patient Admitting De- 
partment has been able to handle the 
many details of admissions efficiently 
and with consideration. The introduc- 
tion of the addressograph plate system 
and the "Rating" of parents according 
to their ability to pay has of necessity 
increased the number of personnel 
needed in this department. The de- 
partment is much too small both from 
the standpoint of patient comfort and 



personnel efficiency. Interviewing 
should be conducted with some degree 
of privacy. Remodeling with parti- 
tions is unthinkable unless the area 
can be air-conditioned. The need for 
more room will not be solved until 
this department can be relocated. 

The increase in the clerical and 
secretarial details of the clinics 
throughout the Out-Patient Depart- 
ment is noticeable. This has produced 
in some instances better controls of 
records, charges, appointments and has 
improved patient satisfaction. Except 
for the General Medical Clinic, an ef- 
fort is made to type into the patient's 
records the dictated clinic visit. This 
is being done in many of the clinics 
and allows the doctor more time to see 
patients, thus cutting the waiting of 
the patient to some extent. 

The reading of former clinic 
notes is no longer a problem and the 
appearance of the record has im- 
proved. In the Surgical Clinic over 
135 clinic notes are typed each week. 
The average in the Orthopedic Clinic 
is 175 each week. In the General 
Medical Clinic a letter is dictated and 
sent to the referring doctor on each 
new patient. An average of 250 let- 
ters a month are mailed. The doctor 
receives a letter explaining treatment, 
diagnosis and disposition of his 
patient. 

An interdepartmental public ad- 
dress system was established five years 
ago in the Medical Out-Patient De- 
partment between the nurses' station 
and the clinic examining areas. This 
has proved a great time-saver in sum- 
moning the various doctors to the 
telephone when they have calls. 

Each clinic worked out a system 
of "Processing Cards" which enables 
them to have a record of the patient's 
visit, his return appointment, and the 
disposition of his medical record. 

The Admitting Office felt the 



need for revision of the addressograph 
plate system which had not been en- 
tirely satisfactory since its establish- 
ment. In 1955 this was accomplished. 
A two plate system was introduced. 
It is now possible to send more de- 
tailed information to areas that need 
it, such as the Accounting Depart- 
ment, by imprinting a three-by-five- 
inch card with the nine-line plate, and 
limited information to other areas by 
the use of the four-line plate. This 
plate is sent to the divisions with the 
patient on admission. 

In an effort to improve the ad- 
mitting procedure and reduce the wait- 
ing time for parents the admission 
forms were studied. A multi-inter- 
leafed form was finally accepted. This 
eliminates the repetitive typing of 
numerous sheets that make up the ad- 
mission record. The Out-Patient ad- 
mitting form was revised at this time, 
thus making both house and out- 
patient forms identical. 

Conclusion. Although much has been 
accomplished within the last five years 
there is still a great deal more to do. 
The entire Out-Patient Department 
needs to be coordinated with more 
centralized control which would tend 
to eliminate the waste of time and ef- 
fort expended caused by the lack of 
knowledge or understanding of ad- 
ministrative policies. 

To improve medical care of the 
ambulatory patient, I recommend more 
regular Staff doctors be assigned to the 
clinics responsible for the follow-up 
of the patient. Follow-up by the same 
doctor is not always possible when the 
house staff doctor, because of other 
commitments, is not in the clinic when 
the patient returns. 

I recommend one emergency 
clinic with space adequate for this pur- 
pose and all emergencies treated there 
day and night. The Surgical Clinic 



131 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



should be reserved for return visits of 
these Surgical patients and all others 
referred to it. 

I recommend improvement in 
methods of rating, coding, budget in- 
terviewing, and charges. 

The above summary has indeed 
tended to emphasize the managerial 
aspects of the department, with little 
mention of the medical aspects. This 
has been intentional, it being realized 
that medical care, teaching, research 
and staffing have been covered in re- 
ports from the medical staff. 

The accompanying list shows in- 
novations, revisions and improvements 
introduced into the major clinics and 
Admitting Office within the last five 
years. 

Dorothy Pratt, R. N. 

Supervisor, 

Out-Patient Department 



O.P.D. Admitting 

Revision of the Multiple Admission 

Forms, with reduction in cost of 

form. 
Both House and O.P.D. admission 

sheets now are identical. 
Introduction of the Addressograph 

System of plastic plates for patient 

identification. 
Revision and improvement of the 

method for handling the following: 

Correspondence 

Appointments 

Follow-up on new patients who fail 
to keep appointments 

Follow-up on B.L.I. referrals. 
Monthly review of M.O.P.D. schedule 

with the Resident to coordinate the 

patient load to the number of doc- 
tors in the clinic. 
Improvement of equipment and physi- 
cal set-up: 

Electric typewriters replacing man- 
ual typewriters 

New desks and chairs 

Ventilator fan 

Improvement of traffic flow 

Pre-Registration Forms. 
Revision of "Parent's Handbook." 

S.O.P.D. 

Addition of full-time secretary. 

Extension of clerical coverage to 11 
P.M. daily plus Sunday and holiday 
coverage. 

Dictation of clinic notes. 

Improvement in correspondence con- 
trol. 

Renovation of the three Operating 
Room tables. 

New chairs and tables for the Examin- 
ing Rooms. 

Installation of air conditioning in Op- 
erating Rooms No. 2 and No. 3, and 
vent fan in Operating Room No. 1. 

Remodeling of Utility Room. 

Improvement in details of clerical job. 

Establishment of a Day Sheet. 



Improvement in method of compiling 
accident statistics. 

Individual Dressing Kits. 

Purchase of additional instruments to 
allow for the preparation of emer- 
gency dressing trays and minor sur- 
gical kits by Central Supply Room. 

Blueprints for further remodeling of 
the department. 

Admitting Office 

Extension of hours to 11:00 P.M. 
daily, Sundays and holidays. 

Introduction of a two-plate system of 
addressographing, with marked im- 
provement in the imprint. 

Introduction of a Multiple Copy Ad- 
mitting Form, and a Day Sheet with 
a single appointment sheet to re- 
place four books. 

A survey of telephone calls. (Reduc- 
tion of calls through wider distri- 
bution of information on admis- 
sions: three-by-five-inch imprinted 
card sent to all residents and physi- 
cians in C.H.M.C.) 

A twenty-four-hour advance notice of 
discharge. 

Revision of "Notice of Discharge." 

Revision of method and format of 
daily Admission and Discharge List. 

Typing and processing of Daily Cen- 
sus Summary ( formerly done by the 
Nursing Office). 

Electric typewriters to replace manual 
typewriters. 

Purchase of an electric Addressograph 
Machine to replace the manual im- 
printer and relocation of equipment. 

Removal of the Telefax Machine to 
the Information Desk; removal of 
Graphotype Machine. 

Revision of "Parent's Handbook." 

Updating of "List of Hotel Accom- 
modations for Parents." 

Free distribution of "Johnny Goes to 
the Hospital." (Continued) 



132 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



MEDICAL RECORDS 



Medical 

Control center remodeled. Laboratory 
moved and remodeled. Secretary's 
office established adjacent to Con- 
trol Center. New floor covering 
throughout. 

Improved method of records control. 

Creation of a dictating station, with 
two dictating machines. 

Introduction of a monthly report of 
letters not dictated. 

Inter-Department P.A. System. 

Orthopedic 

Revision of appointment book. 
Improved method of filing Brace and 

Processing cards and billing. 
Addition of a secretary to the staff. 
Dictation of all clinic visit notes. 
Plaster Room painted and re-arranged. 

Medical Emergency Clinic 

Extension of clinic hours to 11 P.M. 
daily, Sundays and holidays. 

Addition of one staff nurse and one 
nurse's aide. 

Relocation of evening admitting clerk 
in relation to the clinic. 

Remodeling of department with im- 
provement of facilities. Location of 
Poisin Information Office in this 
department to allow proximity to 
the medical doctor who covers this 
service. 

Addition of two telephones with the 
P.U. and H. System. 

Air conditioning of the Isolation 
Room. Vent fan on ventilation sys- 
tem installed. 



The attached statistical report clearly 
indicates the trend of activity in the 
Medical Records Department. It is one 
of continuous increase in the volume 
of records furnished for all uses. This 
increase has added to the recognized 
problem of operating in inadequate 
space. 

The completion of the first step 
of microfilming, with a total of 
171,500 records filmed and filed, al- 
leviated a portion of the storage prob- 
lem. The microtape system was placed 
in use in January. It was interesting 
to note that, after completion, the en- 
tire cost of the system projected to the 
total number of records resulted in the 
surprisingly low figure of approxi- 
mately 23 cents per record. This in- 
cluded preparation of records, filming 
and microtape reproduction set-up, 
cards, indexing, folders, card cabinets, 
reading equipment and storage of 
negative film. There was a ratio of 
better than 8 to 1 of cubic feet saved 
between the space utilized by the cabi- 
nets storing the records and those now 
storing the microtaped cards with 
room for expansion. This alone repre- 
sents a saving in actual cash in operat- 
ing cost, based on the hospital's own 
evaluation of $10,343.00 per year. 
The elimination of replacement of 
cabinets, labor and moving, transporta- 
tion, and time saved, results in an 
additional saving of approximately 
$3,500.00 to $5,000.00 per year. 

The filming of the first group of 
records provided for retention of 
twenty years of active records in their 
original form. A planned program 
provided for retirement of one year of 
records every year. Subsequently, the 
1939 records were filmed and are now 
in file ready for use. 

There is a difference of approxi- 
mately 6,000 records per year between 
the rate of the early years and the pres- 
ent rate of new records issued. There- 



133 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



fore, even though one year of records 
is retired each year, a balance remains 
between those filmed and new records 
issued, so that the filming program at 
present does not solve the storage 
problem. 

In an effort to help with this 
problem, additional space was pro- 
vided in the basement of the Nurses 
Home of the Good Samaritan. Open 
shelves were installed, and records al- 
ready stored there and those from the 
basement of the Main Department 
were moved to the shelves. A total of 
131,900 records were involved in this 
change-over, which was completed 
September 30. An additional 13,025 
records were shifted to the Annex of 
the Main Department. In these moves 
all records were checked and expan- 
sion provided. A total of 244 misfiles 
were found. 

The basement of the Main De- 
partment is in the process of renova- 
tion, and upon its completion a total 
of 126,375 records in the upstairs area 
will be re-allocated, so that new shelf 
space will be available for expansion. 
This move will provide a maximum of 
three to four years' space at the pres- 
ent rate of new records issued. 

During the renovation, the old 
patient's index and diagnostic cards 
were filmed. A total of 273,000 cards 
are now in file on reel film. This pro- 
gram provided for preservation of 
data and release of space. 

With new personnel in all sec- 
tions, progress has been retarded be- 
cause of necessary training. However, 
the Correspondence Section is work- 
ing on a current basis; the Secretarial 
Section is holding the line on tran- 
scription; and the Coding Section is 
slowly making a gain in the backlog. 
In spite of many handicaps, the Filing 
Section has provided continuous good 
service in an ever-increasing volume. 

In August The Children's Hospi- 



tal was approved by The Education 
Committee of The American Associa- 
tion of Medical Record Librarians as 
an affiliated hospital for The Medical 
Librarian School at Massachusetts Gen- 
eral Hospital. A student will be as- 
signed here to spend the month of 
April on an internship basis. 

Plans are in process to start a 
training program for medical secre- 
taries and coding clerks. 

A paper entitled "Microfilm 
Helps a Medical Record Department 



Dig Out From Under," written by the 
Director, was published in the Octo- 
ber I960 issue of the magazine Micro- 
filming and Data Processing. 

The Medical Records Department 
is appreciative of the cooperation, en- 
couragement, confidence and assistance 
of the Administration and of all the 
Departments of the hospital during the 
past year. 

Marie Smith, R.R.L., 

Director, 

Medical Records Department 



STATISTICAL REPORT OF MEDICAL RECORDS DEPARTMENT 






Comparative Totals I960 and 1959 












1960 


1959 


Tabulated Requisitions — Records Pulled 




117,097 


109,081 


(Excluding Department use and Research) 






1960 


1959 






Telephone Calls 41,862 


39,821 






Records Pulled for Research 




10,322 


8,874 


Patients Index — tabulated calls 




79,926 


53,045 


New Records Issued 




15,424 


16,410 


Discharges* 




9,959 


9,906 


Total Operations (including Throat) 




5,590 


5,492 


Correspondence (Requests handled) 




5,477 


5,409 


Income 








I960 1959 









3,581.25 2,905.65 

Photostating (pieces) 

Inter-Departmental Transfers 
401.75 557.10 

Crippled Children — authorizations 
Records Taken to Court 



6,548 

668 

48 



9,512 

664 

27 



Explanatory Remarks: The items Discharges and Total Operations represent the 
work of the collating clerk in preparing the records plus the work of the entire 
secretarial section involving transcription and transmittal for signature. The 
total number of records pulled and calls to the Patients Index, as shown, do not 
represent the total amount of work actually performed, since it is impossible to 
tabulate all requests actually completed. 



134 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



PATIENT EDUCATION AND 
RECREATION 

The Department of Patient Education 
and Recreation during I960 carried 
out the objectives and activities set 
forth by Mrs. Joyce Meyer, the co- 
ordinator, who left the hospital in 
September of 1959. Miss Marcelle 
Hocquet, as senior, in I960 supervised 
the activities of the nursery school 
teachers in the three hospital play- 
rooms in Building B. In the fall of 
I960 Mrs. Nancy Cronce became the 
play teacher in the House of the Good 
Samaritan. The nursery school teacher 
on Division 25 is subsidized by a grant 
from the Daffodil Club. Mrs. Eva 
Pahnke, at the same time, became a 
part-time teacher in a classroom pro- 
gram for children at the House of the 
Good Samaritan. She is subsidized by 
a grant from the Women's Committee. 
Her principal duty is to develop a 
program supplementing the bedside 
instruction provided by the four teach- 
ers from the Boston School Depart- 
ment. 

Mrs. Avis Bray has continued in 
the office of the Department three 
mornings a week and, in addition, has 
continued to assume sole responsi- 
bility for the evening program for 
older children both in The Children's 
Hospital area and at the Good Samari- 
tan. The staff has continued its educa- 
tional activities in the playrooms in 
Building B. There have been twenty- 
two student teachers from Wheelock 
College, eleven each semester, for one 
morning a week. In addition, there 
has been one student from Garland 
School four mornings a week for three 
months and all day for three weeks. 
Two students nurses have been as- 
signed every two weeks for work on 
a full day basis; a total of fifty-two 
nurses have helped with the program. 

Among the volunteers there have 
been three Red Cross workers one 
afternoon each week and others on the 
average of five for one afternoon 



a week. The evening program has 
been somewhat more intensive; a total 
of thirty volunteers have worked eve- 
nings during the year at Children's 
Hospital as well as twenty at the 
House of the Good Samaritan. 

Some of the playrooms were 
closed during the summer months but 
a survey of attendance for the six 
months January to June, I960, shows 
that the total average daily attendance 
in all playrooms was thirty-three chil- 
dren a day for five mornings a week. 

The Committee on Patient Edu- 



cation and Recreation continues its 
search for a coordinator. There is 
some difference of opinion as to 
whether leadership should be selected 
fiom people with an educational back- 
ground or from those oriented in so- 
cial work. 

The Committee hopes that a 
fuller degree of cooperation may be 
achieved in the future with the Boston 
School Department. The potentialities 
of our Medical Center with respect to 
the training of teachers of the handi- 
capped are not being realized. 



DAILY AVERAGE 


ATTENDANCE IN 


PLAYROOMS 




FOR FIVE 


MORNINGS 


A WEEK — 


1960 












Playroom 


25 


Playroom 26 


Playroom 27 


January 








6 




13 


10 


February 








6 




12 


10 


March 








9 




14 


11 


April 








7 




14 


14 


May 








7 




15 


12 


June 








9 




18 


12 


6 mos. average 






7.3 




14.3 


11.5 


July 








6 




11 


— 


August 








— 




19 


— 



Total Average Daily Attendance — All Playrooms 33.1 

PARTICIPATION IN PROGRAM BY 

VARIOUS CATEGORIES OF WORKERS — I960 

PLAY TEACHERS 

Children's Hospital (daytime) 3 

House of Good Samaritan (Miss Shirley Hicks) 1 

Mrs. Avis Bray (evening program plus 3 mornings a week) 1 

STUDENTS 

Student Teachers — Wheelock College, 11 each semester one morning 

a week 22 

Garland School, 1 student for three months, four mornings a 

week plus three weeks all day 1 

Student Nurses — 2 every two weeks for eight hours a day with time 

out taken for classes 52 

VOLUNTEERS 

Red Cross Volunteers — 3 one afternoon each week for textile or 

clay work 3 

Hospital Volunteers — 5 average one afternoon a week, evenings — 30 at 

Children's Hospital, 20 at House of the Good Samaritan 20 



135 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



PHYSICAL THERAPY 



In reviewing the report of the Physi- 
cal Therapy Department, it should be 
remembered that it is more accurately 
the report of the activities of all physi- 
cal therapists in The Children's Hospi- 
tal Medical Center who may be as- 
signed to any one of several work 
areas or departments. These include 
the Cerebral Palsy Nursery School and 
Clinics, the Massachusetts Infantile 
Paralysis Clinics, the Mary MacArthur 
Respiratory Unit and the House of the 
Good Samaritan, as well as the out- 
patient clinics and divisions of Chil- 
dren's Hospital proper. Our respon- 
sibilities also extend to the private 
patients of any staff doctor. 

Patient Care 

Comparison of the statistical report 
for the year ending September 30, 
I960, with that of fiscal 1959, shows 
a decrease of 8 per cent in the total 
number of treatments given (31,158 
vs. 28,902). This is most noticeable 
in the polio out-patient clinics, where 
a decrease of 25 per cent represents 
a fairly large number of patients. 
Other areas showing a marked de- 
crease in referral of patients are 
neurological, 75 per cent, neurosurgi- 
cal, 50 per cent, and Infants' Hospital, 
50 per cent. 

Offsetting this was a 25 per cent 
increase in treatments of polio in- 
patients (9,600 vs. 7,000), mostly in 
the first two months of the fiscal year. 
Except for a slight increase in the 
number of private out-patients, other 
figures remained fairly constant. 

Personnel 

Corresponding to this drop in patient 
load, we have decreased our staff by 
one person. Our present number of 
physical therapists is nineteen, one of 
whom is part-time. The problem of 
obtaining replacements continues to 
be acute and at times necessitates cur- 



tailment of patient load. There were 
five resignations during the year, four 
of them replaced. Three of the four 
occurred in June, but replacements 
were not available until September. 
With a stable supervisory group we 
can adjust to an annual turnover of 
this number in the more junior cate- 
gories. It is interesting to note that 
the five senior (in tenure) members 
of this department represent a total of 
eighty-five years of service to The 
Children's Hospital. 

We have a secretary, clerk, and 
attendant who are responsible for the 
efficient management of the depart- 
ment in the handling of appointments, 
records, correspondence, accounting 
and equipment. Since they also staff 
a reception and information desk at a 
very busy entrance, they are to be 
commended for an excellent job of 
public relations. 

Education 

The hospital continues its affiliation 
with Simmons College in the formal 
teaching and clinical supervision of 
physical therapy students. Five mem- 
bers of our staff hold faculty appoint- 
ments at Simmons, including the Di- 
rector, who also serves as technical 
director of the program within the 
School of Science. During the year 
nine students who received the major 
portion of their teaching here were 
graduated with a B.S. degree and a 
Diploma in Physical Therapy. There 
are two classes of ten and seven each 
currently under instruction. 

Four students from Boston Uni- 
versity's Sargent College and four 
from the Bouve-Boston School of 
Tufts University were accepted for 
supervised clinical practice. One mem- 
ber of the department also serves as a 
member of the Corporation and of the 
Executive Committee of the Bouve- 
Boston School. 



136 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



We have provided roughly 150 
hours of teaching for the Nursing 
School, nursing affiliates and medical 
students. This is an average annual 
amount and does not include many 
hours of informal teaching with the 
resident staff. 

Two post-graduate courses on 
physical therapy in the treatment of 
cystic fibrosis were offered, in Novem- 
ber of 1959 and June of I960. There 
were ten (maximum enrollment) in 
each group, representing nineteen dif- 
ferent hospitals or clinics in twelve 
states. This method of treatment was 
developed in this hospital and has re- 
ceived rather widespread attention. 
Demand for additional courses con- 
tinues. 

Miscellaneous 

Representatives from the department 
have attended five conferences or edu- 
cational institutes of short duration. 

We have had many applications 
from foreign physical therapists who 
wish six to twelve months of affiliation 
here as trainees under the Exchange 
Visitor Program. Unfortunately, our 
budget has not permitted considera- 
tion of these applications, with the ex- 
ception of one from Trinadad who was 
sponsored and financed by the Inter- 
national Cooperation Administration 
for a six-week period. 

We have had many visitors from 
other countries as well as from differ- 
ent states in this country. 

We have been pleased to partici- 
pate in various public relations activi- 
ties, particularly in reference to out- 
side agencies such as the National 
Foundation and United Cerebral Palsy. 
This has involved arranging for photo- 
graphs, demonstrations, tours and in- 
formal talks to interested groups. 

Shirley Cogland 

Director, 

Physical Therapy Department 



ANNUAL REPORT OF THE PHYSICAL THERAPY DEPARTMENT 

October 1959 to September I960 

Individuals 
Polio Cases in the Hospital 234 



Treatments 
9,602 

SERVICES (excluding polio) 

Division 37 — Medical 73 545 

Division 26 — Orthopedic 276 2,964 

Division 36 — Orthopedic 149 1,773 

Division 71 — Respiratory Unit 10 396 

Division 72 — House of the Good Samaritan 10 698 

Division 73 — House of the Good Samaritan 11 550 

Division 25 — Private 24 394 

Division 24 — Surgical 13 203 

Division 34 — Surgical 16 240 

Division 39 — Neurological 21 36 

Division 35 — Cardiac 9 157 

Division 28 — Tumor Therapy 10 127 

Division 27 — Infants' 19 259 

Division 33 — Neurosurgical 33 255 

Division 14 — Throat 3 4 



HOSPITAL PERSONNEL 

BADER BUILDING OUT-PATIENT 
General Clinic 
Privates 

Cerebral Palsy Clinic 
Cerebral Palsy Nursery School 
MIPC Outside Clinics 



911 


18,203 


30 


149 


941 


18,352 


675 


2,134 


499 


1,735 


— 


919 


— 


675 


— 


1,668 




29,004 



137 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



PERSONNEL 



In the past fiscal year nearly 1700 
people have been interviewed by mem- 
bers of the Personnel Department. 
The majority of these applicants came 
to us independently, with approxi- 
mately twenty per cent responding to 
advertisements in local papers, and 
about thirty per cent being referred 
either by an agency or a friend. Not 
included in any of these figures are 
potential members of the nursing 
staff, who are seen only in the Nursing 
Office. 

About 600 employees left in the 
past year, with the highest percentage 
of turnover in Nursing Service and 
those departments in the service areas. 
In reviewing the reasons for termina- 
tion, we have only the information 
which the department head or super- 
visor has supplied on the termination 
report, as the Personnel Office does 
not at this time conduct terminal inter- 
views. 

One of the most important proj- 
ects of this department was the much- 
needed employee handbook, although 
the actual publication and distribution 
will not take place until the beginning 
of the next fiscal year. This booklet 
will be given to all current employees 
and to each new employee when he 
comes on payroll. 

On October 1, 1959, a new bud- 
get system was established by Adminis- 
tration which brought new responsi- 
bilities to this department. Procedures 
and forms were adapted to insure that 
all salary rates and number of em- 
ployees are kept within budgetary 
limits. 

Throughout the year we have 
conducted several surveys both here 
and in other hospitals in the Boston 
area to keep our policies and salary 
scales consistent with these neighbor- 
ing hospitals. 

In May of this year, we had the 
first Annual Service Pin Award cere- 



mony. Before then, each department 
head had presented the service pin to 
an employee on the anniversary of his 
tenth year of employment. All em- 
ployees who have had five or more 
years' service are now invited to this 
annual event. 

In fiscal 1961 there are many pro- 
grams to be developed by the Person- 
nel Department to improve its services 
to the Hospital and its patients. The 
programs must focus on improved 
human relations and better working 
conditions for all employees. 

Specifically, the following plans 
should be inaugurated to attain these 
objectives: 

1. Develop and publish person- 
nel policies and procedures 
which will be equitable for all 
employees. 

2. Establish an adequate wage 
and salary system based on 
recognized job evaluation 
techniques, so that employees 
are paid in relation to work 
performed. 

3. Intensify recruitment efforts 
to provide sufficient and 
proper personnel. 

4. Formalize personnel records 
to provide adequate service to 
supervisors and employees. 

5. Establish an improved budget 
control system. 

There are many other programs 
that must be established in the future 
to provide improved service to our 
patients, such as training courses, 
orientation courses, improved records 
and statistics, but if the above can be 
accomplished this year, I feel that a 
good start will have been made. 

Alexander T. Brown 
Personnel Director 



138 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



VOLUNTEER SERVICE 

Volunteers donated 41,28214 hours of 
their time in the past year in Volun- 
teer Service work to assist the profes- 
sional staff in making our patients and 
their parents feel "comfortable and 
safe." While the burgeoning growth 
of the past five years, during which 
the hours of service increased from 
25,800 to the present total, seems to 
have leveled off, we have experienced 
no sense of being less busy nor have 
any requests for assistance been long 
unfilled. 

The Library volunteers have con- 
tinued to supply an outstanding serv- 
ice while handicapped by their new 
and meager quarters. It has not been 
possible for the same number of 
women to work in such a tiny space 
but they have more than compensated 
by the quality of service they have 
continued to give the patients. 

The branch library, at The House 
of the Good Samaritan, has grown to 
be an important factor in the conva- 
lescent patient's day. 

We were fortunate in obtaining 
pupils from the Boys' Latin School 
Key Club to help prepare the plaster 
casts, a dusty job that held no appeal 
for female volunteers. 

The Gift Shop, under Mrs. H. 
Raymond Wilkinson's guidance, and 
the Coffee Shop, under Mrs. Samuel 
S. Stevens' chairmanship, continue to 
give the same high quality of service 
as in the past and to show a respect- 
able profit. 

During the summer months 
when, because of family responsibili- 
ties, the older women are unable to 
fulfill their volunteer commitments, 
seventy-eight teen-agers served more 
than 8,000 hours. They were students 
at thirty-eight high schools and col- 
leges. The volunteer department sent 
a letter to each school, informing them 
of the students' summer activities. 



A group of Harvard Medical 
School wives met twice a month to 
make surgical dressings. 

A Volunteer Service Committee 
was formed in April to assist and ad- 
vise the Director of Volunteers. It in- 
cludes two members of the Women's 
Committee, chairman of Staff Wives, 
president of House Staff Wives Com- 
mittee, Director of Nursing Service, 
a representative from the Medical 
Staff, the executive secretary of the 
Women's Committee and, ex-officio, 
the Director of The Children's Hospi- 



tal Medical Center and the Chairman 
of the Women's Committee. The com- 
mittee assisted with the Evening Party 
for volunteers. I look forward to con- 
tinued guidance from the committee. 

I was privileged to attend the 
initial Workshop for Directors of Hos- 
pital Volunteers at Boston University. 
The Workshop was instituted at the 
urging of the Greater Boston Council 
of Directors of Hospital Volunteers, 
and proved to be so successful it is this 
year being sponsored by the Massachu- 
setts Hospital Association. 



HOURS OF VOLUNTEER 


SERVICE 




Oct. 1959 


Oct. 1958 


SERVICES 


Sept. I960 
1,346 


Sept. 1959 


Administrative Aides 


2,0471/2 


Admitting Hostesses 


1,4213^ 


1,4571/4 


Blood Bank 


34834 


34134 


Central Supply 


— 


62 


Christmas Decorations 


751/2 


— 


Feeding 


1,04414 


l,02U/ 2 


Gift Shop 


6,8941/2 


9,26734 


Good Samaritan 


3,3171/4 


— 


Information Desk 


4201/2 


4811/2 


Laboratory 


1,32914 


30 


Library, Patient 


1,031 


2,1973/4 


Lunch Shop 


7,447 


8,195 


Medical Records 


1431/2 


— 


Mended Hearts 


11/2 


3 


Parents Teas 


2161/2 


208 


Pharmacy 


13 


— 


Photography 


162 


1131/2 


Plaster Room 


5751/4 


— 


Post Office 


183 1/2 


27434 


Recreation 


3,0301/2 


5,9801/2 


Red Cross Aides 


799 


9411/2 


Social Service 


681/2 


671/2 


Surgical Dressings 


9531/2 


6791/4 


Transportation 


4,993i/» 


3,994^4 


Volunteer Aides 


1,9641^ 


3,295i/2 


X-Ray 


329 3 4 


42 


Totals 


41,2821,4 


44,1801/2 



139 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



DIETARY 



As a member of The Children's 
Hospital Speakers Bureau, I gave talks 
before several fraternal organizations, 
church groups and to The Jordan 
Hospital Auxiliary. I served as chair- 
man of the committee to re-vamp the 
by-laws of the Greater Boston Council 
of Directors of Hospital Volunteers 
and for a two-year period will be the 
recording secretary of the council. 

A salaried secretary has fulfilled 
a long-standing need in the volunteer 
department. 

The attached statistical report in- 
dicates the various types of work our 
volunteers are performing for the hos- 
pital, but does not relate even a part 
of the devotion given to this institu- 
tion by the volunteers. 

I would like to express my deep 
appreciation to Administration, Staff 
and the Women's Committee for their 
continued support and assistance, and 
to the Volunteers who make the report 
necessary and possible. 

Kathleen Higgins 
Director, Volunteer Service 



The dietary department of The Chil- 
dren's Hospital Medical Center has as 
its primary responsibility the prepara- 
tion of all meals for its patients, in- 
cluding those of the Judge Baker 
Guidance Center School. In addition 
to this and far more time-consuming 
is the operation of the staff and em- 
ployee cafeteria which often provides 
more than 2,000 meals per day. 

During the past year our depart- 
ment served 240,030 regular meals 
and 29,565 special diet meals to pa- 
tients. In the staff and employee cafe- 
teria, 491,558 meals were served. In 
addition to providing these meals, the 
department is called upon to supply 
refreshments to such areas as the blood 
bank, the surgeons' and scrub nurses' 
lounges and to many of the meetings 
and conferences held at the Medical 
Center. 

The dietary department has a 
staff of 65 (41 full-time, 24 part- 
time) persons who plan all meals, pur- 
chase and prepare all the food, and 
serve in the cafeteria. 

Meals for the patients are pro- 
vided in bulk in heated trucks to the 
floor or sub kitchens where they are 
put on trays and served by the nursing 
department. The management of the 
floor, or sub kitchens on the patient 
divisions by the nursing department 
is under study and it is possible that 
the dietary department will assume 
that responsibility during the coming 
year. This should relieve the nurses 
and their aides of the tasks of setting 
up patients' trays, give the dietitians 
better control over the management 
of these kitchens, and provide for 
more direct contact between patient 
and dietitian. 

With the exception of the main 
kitchen, the activity of the dietary de- 
partment has far outgrown its present 
quarters. The staff and employee din- 
ing room serving facilities and dish- 



washing equipment are no longer ade- 
quate to handle the volume of feed- 
ing. Long lines waiting at the cafeteria 
at meal time give evidence to this 
problem. The immediate need here is 
to increase seating space in the dining 
room, enlarge and improve the dish- 
washing facilities, and add another 
serving line or increase our present 
serving facilities. 

Martha Stuart 
Head Dietitian 



140 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



PURCHASING 



In the past year the Purchasing De- 
partment has experienced the in- 
creased activity that naturally would 
be associated with the vast expansion 
in all Hospital departments. Changes 
in personnel and additions to existing 
staff are immediately reflected in this 
department in the requests for office 
furniture, typewriters, medical and 
surgical supplies, instruments — in fact, 
any or all the tools required to accom- 
plish the projected assignment. 

In the early part of the year Mr. 
Joseph P. Greer outlined and effected 
certain necessary changes in purchas- 
ing procedure by Hospital departments 
from General Funds. To take full ad- 
vantage of centralized purchasing it 
has been necessary to insist that all 
requisitions be processed via Purchas- 
ing after receiving administrative ap- 
proval. The routing of all orders 
through a single office has prevented 
duplication of shipments and allowed 
combination of identical orders result- 
ing in competitive and quantity pur- 
chasing. 

Some 15,000 purchase orders 
were sent to vendors, each resulting in 
a subsequent invoice which was 
checked as to receipt, verified for pric- 
ing, coded and forwarded to Account- 
ing for payment. A perpetual inven- 
tory is kept on 1,500 items stocked for 
general use, including medical, surgi- 
cal and laboratory supplies, blankets, 
sheets, pillow cases, printed forms, 
stationery and office supplies. 

Our hospital is a charter mem- 
ber of the local Hospital Purchasing 
Corporation, founded in 1952, and the 
Purchasing Agent is a member of the 
Standardization Committee working 
with this organization. A recent arti- 
cle appearing in the Journal of the 
American Hospital Association re- 
cords a most enlightening appraisal of 
seven successful years of group pur- 
chasing. Bi-weekly committee meet- 



ings are held, and every possible means 
of effecting savings is explored and 
utilized. Pooling both the knowledge 
and supply requirements of many Hos- 
pitals in the Boston area into large 
volume purchases with definite speci- 
fications or standards is one proven 
way of obtaining substantial savings 
without sacrificing quality. An inter- 
esting and current topic is the trend 
toward the contemplated use of "dis- 
posables" as a change from the stand- 
ard (reusable) product in many sec- 
tions of the Hospital, Patient areas — 
Laboratories — Central Supply Service, 
etc. These disposables are designed for 
convenience, utility, and economy in 
saving valuable time by eliminating 
such tedious tasks as cleaning, wash- 
ing, sterilizing, since the item is used 
once and discarded. 

While labor-saving studies reveal 
that the time and wages of personnel 
involved in preparing reusable items 
are the compensating factor, the cost 
is an all-important consideration. 

To point up the increase in cost 
on one item in general use between 
patient division and Laboratories, the 
following statistics are revealing. A 
glass specimen collector purchased in 
quantities of one gross per year at a 
total cost of $130 for the year has been 
replaced by a one-time use article at a 
cost of $3,000 per year. This increase 
in expense is offset, first, by the safety 
factor which had long been desired, 
second, by sterility, and, third, by prob- 
able savings in labor. None of these 
considerations can be evaluated on a 
dollar basis. 

The staff presently consists of the 
Purchasing Agent, Assistant, two pur- 
chase order clerk-typists, an inventory 
clerk and an invoice clerk. In the Re- 
ceiving Room we have the head Store- 
man, an Assistant and three helpers. 
With the exception of one helper 
added to the Receiving Room Staff last 



summer, this is the same number of 
employees serving in the department 
ten years ago. This staff is not con- 
sistent with the expansion previously 
referred to, but anticipated changes in 
processing Special Fund activities is 
under consideration, and much clerical 
work not essentially purchasing may 
be channeled elsewhere. 

Elizabeth Fitzgerald 
Purchasing Agent 



VISUAL EDUCATION 



141 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



In reviewing the past year's work it is 
informative to list the many kinds of 
photography employed by the Depart- 
ment in its production of material for 
visual education in the medical field. 
We photograph patients for the medi- 
cal record, which is a basis for teach- 
ing material and an invaluable pic- 
torial record of the individual patient's 
progress to health. We make motion 
pictures of gait, growth and neurolog- 
ical problems. From time to time 
teaching motion pictures of surgical 
procedures are made. Magnetic sound 
is added if needed and is recorded 
here. We do a great deal of color 
photography for many purposes, but 
do not produce color prints. We make 
standard and 2x2 lantern slides in 
large quantities. We do both photo- 
macrography and photomicrography. 
A lot of flat copy is made as the first 
step in making lantern slides and 
prints. We illustrate scientific papers 
and books. Several thousand X-rays 
are reproduced each year as prints and 
lantern slides. Exhibits for the many 
departments and services of the hos- 
pital are planned and made as needed. 
We are consultants on technical photo- 
graphic problems related to the bio- 
photographic field. We also do spe- 
cialized photography by infra-red 
light and occasionally under ultra- 
violet light. Much laboratory equip- 
ment requiring highly specialized 
lighting conditions is also photo- 
graphed. New applications of photog- 
raphy are constantly being found use- 
ful in the medical field. 

Our patient load showed an in- 
crease of over five hundred photo- 
graphs in the past year. An increase 
of 44 per cent was noted in the pro- 
duction of 2x2 (35mm) black and 
white lantern slides. Standard lantern 
slides increased 36 per cent. Motion 
pictures increased by 13 per cent. The 
trend is ever upward. 



Thanks to the Women's Com- 
mittee, whose grant of funds enabled 
us to purchase an electronic printer, 
we are now able to produce much 
better prints of X-rays than before. 
The machine is also very useful in 
difficult photographic printing prob- 
lems involving patients. We are most 
appreciative. 

It probably will be necessary to 
hire someone for vacation relief dur- 
ing the coming summer. This year 
the problems were most difficult with 
a vacation period spreading from late 
June to the end of September. We 
are operating the department with a 
total staff of four, while in other in- 
stitutions doing an equal volume of 
work the staff is usually six persons. 
So far we get along very well when 
the whole staff is present. 

In August I attended the annual 
meeting of the Biological Photo- 
graphic Association at Salt Lake City, 
Utah. Several new techniques may 
have application here, after further 
study. 

The one paper published this year 
is "Radiographic Reproduction," F. R. 
Harding, FBPA, Jour. Biol. Photo. 
Assn. Vol. 28 #2. 

This has been a very busy year 
for the department. I wish to thank 
the staff for its cooperation. I should 
like to especially thank my own staff 
for their wholehearted cooperation. 

F. R. Harding, Director 
Visual Education Department 



STATISTICAL REPORT OF DEPARTMENT 
OF VISUAL EDUCATION I960 



Service 
Orthopedic 
Surgical 
Neurosurgical 
Medical 

Tumor Therapy 
Infants' Hospital 
Pathology 
Private Division 



Cases Photos 

559 2037 

262 705 

112 270 

605 1249 

472 1438 

55 115 

375 731 

384 1142 



Private Office Patients 193 536 

M.I.P.C. 35 114 

C P. Clinic 17 126 

Neuro-medical 18 66 

Child Health 7 12 

Adolescent Clinic 13 31 

Dental Clinic 9 33 

New Born Nursery 2 7 

X-Ray Therapy 6 14 

Seizure Unit 2 3 

Respirator Unit 1 2 



Total 3152 


8725 


Misc. Negatives 


2594 


Misc. Prints 


5632 


Black & White Lantern 




Slides 2x2 


1532 


Black & White Lantern 




Slides Standard 


1624 


Color Slides 2x2 


446 


Color Slides Standard 


220 


Motion Pictures 


315 


Motion Picture Footage 


14,310 ft. 


Total Negatives 


11,298 


Total Prints 


14,357 


Total Charges 


$16,222.20 



142 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



PHARMACY 



The fiscal year I960 was eventful for 
the Pharmacy. In June, it moved into 
the area formerly used by the blood 
Donor Department, giving the Phar- 
macy 250 square feet of good work- 
ing space and space for the efficient 
storage and dispensing of most phar- 
maceuticals used in the hospital. 

The inner room of the old Phar- 
macy was retained and plans have 
been drawn to use it for manufactur- 
ing bulk pharmaceuticals, sterile in- 
jectable vials, washing bottles and the 
storage of some state-owned drugs. 
All volatile solvents, including alcohol 
and ether, must be stored in the cellar 
beneath the Admitting Office to con- 
form to fire and safety regulations. 
These heavy materials are lowered 
from the street level by means of a 
hand-operated, antiquated elevator 
only to be carried to the street floor 
by means of a dangerous spiral stair- 
way, when needed for use within the 
hospital. 

The volume and value of the 
drugs dispensed by the Pharmacy was 
approximately $250,000 in the past 
year. The advent of antibiotics, such 
as penicillin, chloramphenicol, erythro- 
mycin, has increased the cost of oper- 
ation tremendously but has reduced the 
average patient stay in the hospital. 

The Pharmacy of the Children's 
Hospital is confronted with different 
problems than other hospital pharma- 
cies because it must dispense medi- 
cines in a suitable dosage range con- 
venient for the nurse to administer 
and palatable to the child. Most phar- 
maceuticals are manufactured for 
adults with little or no attention di- 
rected to pediatrics. Examples: 

Several strengths of sterile nar- 
cotics are prepared in the Pharmacy 
and are available in graduated vials 
for the convenience of the nurse in 
accounting for these drugs. The Phar- 
macy annually prepares approximately 



1000 of these vials, which are not 
commercially available because of the 
small doses required for children. 

Tablets and capsules of drugs 
containing adult doses, but used for 
children, are quickly diluted and made 
into capsules of convenient doses by 
means of a hand operated capsule ma- 
chine capable of making 100 capsules 
at a time. This same machine is also 
used to make capsules of investiga- 
tional drugs. A few of the important 
capsules made with this machine this 
year were potassium perchlorate 250 
mg., penicillamine 250 mg., neomycin 
sulfate 100 mg. and 250 mg., and 
isoniazid 10 mg. 

Approximately 5000 five Gram 
vials of penicillin were reconstituted, 
or dissolved, under aseptic conditions, 
properly labeled with strength and 
expiration date this past year. This 
penicillin, along with streptomycin 
was delivered to the divisions three 
days weekly, at which times the sup- 
plies were checked for expiration 
dates and supplies replenished, if 
needed. Considerable saving in nurs- 
ing hours resulted. 

It is the intention of the Phar- 
macy to supply chloramphenicol, 



erythromycin in a ready to use, sterile 
vial in 1961 rather than to send it to 
the division in a dry form, requiring 
its reconstitution by a nurse. This can 
be accomplished by the addition of a 
freezer, which will allow the prepara- 
tion of many vials at one time. Most 
of these drugs are quite stable in the 
frozen condition but quite unstable in 
liquid form. 

Routine stock drugs for the di- 
visions were delivered daily upon re- 
ceipt of a requisition and all empty 
bottles and returns were picked up 
on this delivery. Many special medica- 
tions for individual patients were de- 
livered to the divisions at this time. 

The Pharmacy is always glad to 
aid any laboratory or doctor to obtain 
any hard to get chemical and to pre- 
pare it in a convenient dosage form, 
if desired. 

The most time-consuming job in 
the Pharmacy is the dispensing of 
prescriptions to out-patients; these 
number over 100 daily. Drug stores 
figure it takes six minutes to dispense 
a simple prescription, but much less 
time is required here. 

The Pharmacy, in addition, dis- 
penses, and accounts for all the vari- 



RELATIVE CONSUMPTION OF DRUGS BY PROGRAM OR SERVICE 



Chronic disease program 
prescriptions 




Out-patient prescriptions 



Laboratory supplies 



Division supplies 



Cancer Research Foundation 



antibiotics 



FIGURE I 



143 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



SPECIAL SERVICES 



ous drugs used under the Chronic Dis- 
ease Program and purchased by the 
Commonwealth of Massachusetts. 
About 1200 patients with cystic fibro- 
sis, requiring from one to 12 individual 
drugs, and about 1000 seizure patients, 
requiring one to five drugs each time, 
were served by the Pharmacy. The 
average state-owned inventory stored 
in the Pharmacy is about $25,000. 

A detailed monthly report is pre- 
pared for the Administration and 
Comptroller, with special sections for 
the Health Department of Massachu- 
setts, Director of Nursing, and the 
Cancer Research Foundation. This 
report furnished the Administrator 
and Comptroller with the cost of drugs 
dispensed to patients, divisions, labo- 
ratories as well as the charges to the 
patients. 

The Pharmacy is staffed by four 
pharmacists, including the chief phar- 
macist, and one helper. It is apparent 
from this report that the staff is hardly 
adequate to accomplish all that is 
necessary. It is hoped that an addi- 
tional pharmacist, secretary, and office 
space for the Pharmacy may be ob- 
tained in the coming year. 

Arthur M. Thompson 
Chief Pharmacist 



This new administrative department 
was established this year for more ef- 
fective supervision of our parking lots, 
security program, elevator operators, 
apartment houses and grounds. It also 
will be responsible for many of the 
administrative arrangements of special 
functions held at the hospital. 

1. Parking Lots. 

The parking management pro- 
gram has been functioning effectively 
for two years. Basically it requires all 
parents, visitors and staff to pay 25 
cents daily for parking and all regular 
employees and staff $2.00 per month. 
Volunteers and unpaid house staff are 
issued free permits. The proceeds, ap- 
proximately $35,000 per year, are used 
to pay for professional parking at- 
tendants and for the physical main- 
tenance of the lots. 

The increased number of places 
resulting from more efficient use of 
our available space has brought a 
favorable reaction, particularly from 
our out-patient parents. Many com- 
ment that prior to the establishment 
of this system it was extremely diffi- 
cult to get their children into our 
clinics because they were unable to 
park near the Hospital. The 2 5 -cent 
fee is established only to cover the 
cost of operating the lots. 

2. Security program. 

The Hospital purchases the serv- 
ice from an established detective 
agency. It provides both a crew of 
uniformed night watchmen and the 
services of a licensed detective if 
needed. The difficulty of policing our 
seventeen buildings, covering several 
city blocks, most of which are open 
twenty-four hours a day, cannot be 
overstated. As in any institution, the 
most effective safeguard against losses 
is alertness and care on the part of its 
employees and staff. 

3. Apartment Houses. 

The Hospital owns forty apart- 



ments at 329 and 333 Longwood Ave. 
In addition it now has thirty-five to 
forty rental rooms at the House of the 
Good Samaritan Nurses Home at 19 
Peabody Street. The majority of the 
apartments are rented to members of 
the nursing staff at somewhat below 
the local rates. The rooms at 19 Pea- 
body Street are assigned to the female 
house staff, staff nurses and employees. 

4. Grounds and Landscaping. 

Our present grounds crew num- 
bers four and is charged with main- 
taining our lawns, shrubbery, remov- 
ing snow, decorating for holidays and 
countless other tasks. 

George T. Nicoll, 
Director, Special Services 



COMMUNICATIONS 

The extensive and ever-increasing use 
of hospital telephones places heavy de- 
mand on our operators, our switch- 
board and our budget. We require 
twelve operators to give round-the- 
clock coverage of thirty-five outside 
lines and nearly 700 hospital tele- 
phones. 

Equally important is the respon- 
sibility placed upon the operators for 
tracing the location of hundreds of 
staff and resident doctors and other 
key personnel. Extensive directories 
and call lists are maintained for this 
purpose but the operators' memories 
are the key to this service. 

The cost of telephones, exclusive 
of salaries, for the past year was ap- 
proximately $110,000 or nearly $329 
per day. 

Ruth C O'Brien 
Chief Operator 



144 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



EMPLOYEE HEALTH SERVICE 



The Employee Health Service was in- 
augurated as a new department at The 
Children's Hospital Medical Center in 
January, 1959. Following a survey of 
nine hospitals in the Boston area re- 
garding policies and services for em- 
ployees and subsequent administrative 
consultation, it was deemed wise to 
establish our program on a limited 
basis and thus determine the needs and 
requirements of this hospital. 

Although the department has 
been functioning for only twenty-one 
months, a fairly rapid development 
has demonstrated the need and use of 
this service by employees. All hospital 
personnel, with the exception of stu- 
dent nurses and staff nurses, are cur- 
rently covered by this service. 

The incidence of time lost from 
Industrial Accidents has been substan- 
tially reduced. Minor injuries can be 
treated at the Employee Health Service 
with a minimum of time being spent 
away from the department. Hereto- 
fore, injured employees were referred 
to a clinic and the usual delay of Out- 
patient care frequently involved many 
hours. In view of the fact that there 
is no historical background, it is diffi- 
cult to estimate this saving in dollars 
and cents. 

Pre-employment physical ex- 
aminations, medical advice, check-ups, 
nursing consultations, ancillary serv- 
ices when indicated, polio inoculation, 
travel immunization, influenza vac- 
cine and referrals to other hospitals 
and/or private physicians constitute 
the service offered. This program pro- 
vides one more fringe benefit offered 
by The Children's Hospital Medical 
Center to its employees. 

On July 1, I960 The Children's 
Hospital Staff Association employed 
the professional services of Dr. Robert 
J. MacMillan to give medical care, 
physical examinations and complete- 
immunizations. This service for the 



House Staff is provided in the Em- 
ployee Health area. 

In March, I960, a tentative pro- 
gram providing health coverage for the 
Judge Baker Guidance Center em- 
ployees was submitted. Formal ar- 
rangements on a contractual basis have 
been approved. 

It would be an omission not to 
point out two factors that are impor- 
tant to the service in the future. 

(1) The Employee Health Serv- 
ice is infringing on the Per- 
sonnel Department space 
which is shared as a waiting 
area for prospective job ap- 
plicants and ill employees. 

(2) The Children's Hospital 
Medical Center is spending a 
substantial amount of money 
for health service. As we 
look to the future, a co- 
ordinated plan for health 
services for all employees 
should be contemplated 
with increased medical cov- 
erage, more clearly defined 
policies and improved fa- 
cilities. The hospital would 
benefit immeasurably by 
such a program. 

A summary of statistics is attached. 

Hester E. Macuen, R.N. 

Director, 

Employee Health Service 



STATISTICS FOR 

EMPLOYEE HEALTH SERVICE 

Physical examinations 436 

Medical visits and check-ups 631 
Nursing visits and 

consultations 1,347 

Polio inoculations 230 

Polyvalent flu vaccine 335 

Other immunizations 57 

Total 3,036 

Average monthly visits 253 

Referred for X-Rays— CHMC 58 
Referred for Lab Work— CHMC 54 

Referred for E.K.G.— CHMC 9 

Industrial Accidents treated 64 

Referred to Peter Bent Brigham 36 

Referred to Mass. Eye and Ear 8 

Referred to Other Hospitals 8 

Referred to Private Physicians 51 



Safety Committee. The Medical Cen- 
ter's Employee Safety Committee has 
met monthly during the past year and 
carefully reviewed every on-the-job 
accident. There are about twelve mem- 
bers representing the major depart- 
ments. 

In addition to investigation of 
each accident with an eye to eliminat- 
ing the cause, the committee sponsors 
safety publicity, maintains a safety 
bulletin board and makes many recom- 
mendations on working hazards. 

The Workmen's Compensation 
self-insurance program has again 
meant considerable savings to the 
Medical Center. Costs for the calendar 
year I960 should be well below 50 per 
cent of our normal premium. The 
number of accidents involving lost 
time continued to decline during 
1960. 



MAINTENANCE 



145 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



This past year probably can be con- 
sidered a more nearly normal year for 
the Maintenance Department than 
those immediately preceding because 
the basic remodeling program, started 
in 1956, had been substantially com- 
pleted. While the activities of the de- 
partment have not been as frenetic as 
those other years, there seems to be a 
level, about that of a dull roar, below 
which it seems The Children's Hospi- 
tal Medical Center does not operate. 

As far as large construction high- 
lights are concerned, there are not 
many to report. The pharmacy dis- 
pensary was re-designed and moved to 
the location of former blood donor 
rooms with slight alterations. De- 
centralized out-patient cashier facili- 
ties and several laboratories were de- 
signed and installed. The student 
nurses kitchen in the Gardner House 
was modernized. And, of course, con- 
siderable numbers of air conditioners, 
sinks, counters, refrigerators and freez- 
ers, etc., were installed, all requiring 
power or plumbing facilities. 

That the institution is constantly 
becoming more machine equipped 
throughout is apparent in the increase 
in the amount of electrical power used 
each year. The power consumption in 
1959 was 15 per cent higher than in 
1958. Early this year a new trans- 
former was installed near the Main 
Building and considerable switching 
changes were made for the Carnegie 
and House of the Good Samaritan 
buildings to correct unbalanced loads 
created by our increasing new de- 
mands. These installations were made 
without incident, though many power 
shutdowns were involved. 

Much of our activity relates to 
"fixing" things for other departments. 
In the cause of record simplification 
we do not keep complete cumulative 
records of all work performed. But 
October's activity may be considered 



as normal to show what is done 
throughout the year. About 100 
maintenance orders were received 
from the various departments to re- 
pair, fix, or adjust equipment involved 
in their operation. A sampling shows 
this variety: 

Aquarium pump, toasters, scales, 
stethoscope, laundry truck, TV's, 
hot pack machines, hi-fi's, deep 
freeze, isolettes, go-carts, step- 
ladder, radios, hair dryer, tables, 
lamps, bottle warmer, respirators, 
etc. 
Much more of this work was per- 
formed on a routine maintenance 
basis, such as sterilizer checks, iso- 
lettes cleaned or repaired, plaster 
traps cleaned, air filters replaced, etc. 
To this routine is added the phone call 
load, varying from day to day but esti- 
mated at several hundred a month, to 
perform similar jobs of urgent nature. 
There are about 1,500 rooms of 
various kinds in our main building. 
Mr. Morris J. Reardon, our "light bulb 
man," replaced 785 light bulbs in 
those rooms during October and in 
addition traversed every corridor and 
stairwell in Buildings A, B, C and Bader 
each day checking and replacing bulbs. 
This represents our basic lighting 
maintenance program, for which we 
use about forty-five different sizes and 
types of bulbs. Along this same line 
we purchased in the past six months 
about 250 electronic tubes of great 
variety for use in our increasingly 
complex equipment, such as medical 
record card files, pneumatic tube con- 
trols, TV and radios, and the potwasher 
for the main kitchen. 

We made things, too, for the 
other departments; in October we pur- 
chased 2,080 square feet of plywood, 
masonite, etc. and 500 linear feet of 
1 x 12 lumber for tables, counters, 
shelving, etc. Our own painting de- 
partment bought (and used) 409 gal- 



Ions of paint last year. Considerable 
contract painting also was performed. 

During the year, amidst the re- 
pairing and building for others, roofs 
were fixed, sidewalks patched, snow 
cleared, cars parked, sinks unplugged, 
washers changed, fuses replaced, signs 
made, bearings oiled, traps cleaned, 
pumps repacked, rooms painted, floors 
repaired, pictures hung, leaves raked, 
lawns mowed, clocks set and keys 
made. 

And finally we succumbed to pub- 
lic opinion and renovated our office. 
It now looks so nice that eviction 
notices would come as no surprise. 

Arthur Stomberg 
Plant Superintendent 



146 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



SURGICAL APPLIANCE SHOP 



In the period from June 6 to October 
1, the Surgical Appliance Shop has 
tried to center its interests on the fol- 
lowing problems: 

1. To ascertain an accurate hourly 
rate, based on over-all costs, which can 
be applied toward a review of prices 
generally as well as repair work. In 
the area of overhead expenses, we plan 
to pin down the cost to the Depart- 
ment for vacations, holidays, coffee 
breaks, stationery, etc., and relate them 
to the over-all cost of braces in 
general. 

2. A cost analysis of the manufac- 
ture of our braces (leg braces in par- 
ticular). We have been concerning 
ourselves not only with the cost of 
machining and forging our own parts 
for leg braces, but also with the labor 
time involved in the assembling and 
finishing. We are also trying to deter- 
mine an average time for measure- 
ments and fittings. 

3. The time-clock work-cards 
which we now use: These cards are the 
means by which we obtain our labor 
costs for a given brace. However, the 
system we presently have distorts the 
picture for us and has delayed our pre- 
senting any final figures as to the pres- 
ent cost of manufacture of any particu- 
lar type of brace. 

4. The constant flow of repair 
work which comes in to this shop in- 
terrupts the production flow of new 
appliances, and causes, to the staff and 
patients, exasperating time delays in 
delivery. There is no question in my 
mind but this problem will be with us 
for some time, because it is related to 
our present brace design. As new de- 
signs are accepted by the staff, we ex- 
pect to eliminate gradually the bulk of 
repair work. It has been my experi- 
ence in the past that the one type of 
repair work that cannot be eliminated 
is the replacing of leather on various 
splints, since there is at present no 



covering material available that will 
last the life of the brace itself. 

5. The methods of prescribing, 
and more especially the prescription 
forms now available to the staff, are a 
source of annoyance to both the staff 
and the department for the reason that 
no accepted nomenclature has been 
worked out. At present this lack of a 
common terminology leads to many 
problems, especially remaking, because 
of misunderstandings; and as is so 
often the case, the patient is not seen 
by the braceman, and therefore the 
doctor's prescription should be precise 
and complete. 

6. We find that in the past there 
have been several men doing measur- 
ing and fitting, each having his own 
methods. This, of itself, is not bad, 
provided each individual method is 
based on sound knowledge. The weak- 
ness of too individualistic an approach 
makes for unnecessary complications 
in production control and efficiency. 
When each man has his own tech- 
nique, he alone is the only one who 
can follow through to completion on a 
particular brace. A series of instruc- 
tion sessions are planned (tentatively 
one hour per week) in which we aim 
to combine the best fitting techniques 
of each individual and have the group 
adopt them. We also would like to 
include in these sessions a spelled-out 
method of measuring for various ap- 
pliances in terms of anatomical land- 
marks. We feel that this will enable 
all of us to understand one another 
better, and will facilitate more flexible 
assignment of the work. 

7. There are a number of types 
of braces, such as Whitman plates or 
any spinal brace which requires a 
form-fitting mold, which necessitate a 
negative cast taken on the patient, 
which in turn is used to make a posi- 
tive model to which the molded sec- 
tions are shaped. Presently these nega- 



tive molds are taken by the physician 
or plaster technicians in the O.P.D. 
plaster room. The patient would not 
be seen by the braceman until many 
hours of labor and much material had 
been used on the brace, whether the 
brace would be in the fitting or com- 
pleted stage. This practice is extremely 
wasteful and is very unsatisfactory to 
both physician and patient, since often- 
times what has been completed is in- 
adequate and must be discarded, or 
remade in such a manner that ma- 
terials and labor will be doubled. This 
problem will somewhat solve itself in 
the future, since we hope to cover the 
clinics more closely and give better 
service to the staff. In this way, we are 
on the spot when a brace is discussed 
and can see the problems first-hand 
and get whatever further details we 
feel will be necessary before starting 
the appliance. This should save a con- 
siderable amount of extensive altera- 
tions. 

8. When a brace is completed, 
rather than have the patient come to 
the Appliance Shop for a final fitting, 
the brace is sent to the clinic, and the 
clinic in turn notifies the patient to 
come in. The brace is then applied at 
clinic by the physician. Consequently, 
little minor adjustments which mean 
so much to patient comfort have to be 
done on the spot without being 
planned. The doctor's time has been 
wasted on the obvious, examining 
rooms in the clinic are tied up un- 
necessarily, and it is my feeling that, 
most important of all, a good relation- 
ship between the department, physi- 
cian, and the patient is seriously com- 
promised. 

The system of brace deliveries 
has been revised, and seems to be 
working quite well. Instead of our 
sending the brace to the Clinic for ap- 
plication by the physician, we now 
notify the Clinic when a brace is fin- 



147 



REPORTS OF ADMINISTRATIVE DEPARTMENTS 



HOUSEKEEPING 



PRINT SHOP 



ished. The patient is sent an appoint- 
ment by the Clinic; he registers, and is 
sent to the Appliance Shop. The brace 
is then put on him at the Shop, and 
minor adjustments can be caught then 
and there. When the brace is satisfac- 
torily fitted, the patient is sent to the 
Clinic and the Doctor gives the brace 
a final check. To date, with this 
method, we have caught many minor 
details in advance of the Clinic, and 
we believe it will save a good many 
people's time in the future. 

Perhaps in the future it would be 
wise to think about combining in this 
area some general information for the 
patients or their parents which would 
instruct them in maintenance of the 
brace in terms of longer life and less 
repair. It is possible that the best ap- 
proach to this maintenance problem 
would be a few simple instructions 
printed on a card and given to each 
patient at the time the brace is re- 
ceived. We feel that little is done 
along these lines in the Clinic area 
since no one has the time to do so. 

Inventory system. In the coming year, 
it would be advantageous to install a 
perpetual inventory system, since our 
present set-up, oftentimes due to ma- 
terials running out, causes delays in 
deliveries. We feel that an inventory 
system would prevent much of this 
annoyance. 

We feel that the over-all ap- 
proach, as outlined above, will result 
in substantial progress during the com- 
ing year. 

John Glancy, 
Manager, Surgical Appliance Shop 



Maintaining cleanliness in an institu- 
tion of some 17 buildings with such 
varied uses as exist at The Children's 
Hospital Medical Center is indeed a 
difficult task. During the past year the 
housekeeping department has endeav- 
ored to get this work done with a force 
of approximately 100 people and an 
expenditure of nearly $300,000. 

The most serious problem facing 
our department is the procurement 
and retention of qualified personnel. 
Our turnover rate exceeded 100 per 
cent during the past year, making it 
extremely hard to provide good serv- 
ice. The primary causes for this rapid 
turnover appear to be a low wage 
scale, barely above unemployment 
compensation in some cases, inade- 
quate employee facilities such as 
locker rooms and employee lounges, 
and the lack of an organized incentive 
program in which the employee can 
improve his standing. All these prob- 
lems are getting active attention and 
within budgetary limits a real effort 
is being made to improve these con- 
ditions. 

The varied uses of the 17 build- 
ings — a sampling of which includes 
patient rooms, operating rooms, public 
corridors, doctors' offices, animal 
rooms, dormitory rooms, and dental 
offices — make cleaning a complex 
problem. Emphasis must, of course, 
always be placed on the patient and 
clinical areas. The importance of 
cleanliness in hospitals is obvious. The 
role of the cleaning man must be 
recognized and every effort made to 
dignify his or her job both socially 
and financially. Only by doing this 
will we maintain the high standards 
required. 

Frank W. Dickey 
Executive Housekeeper 



In 1956 the Medical Center expanded 
its duplicating room from a simple 
electric mimeograph with one opera- 
tor into a more up-to-date printing 
shop with an offset duplicator. Since 
that time the shop has added two per- 
sons to its work force, and to its 
equipment it has added a folding ma- 
chine, punch press, graph duplicator, 
light table, paper cutter, collator, photo 
copy vacuum exposure frame and elec- 
tric stapler. 

During the fours years of opera- 
tion the volume of work has risen 
sharply. The shop now does, in addi- 
tion to all of the duplicating, a large 
portion of the Medical Center's print- 
ing. Work from affiliating institutions 
and neighboring hospitals has been ac- 
cepted to maintain a uniform work 
load. The dollar volume of this out- 
side work amounts to $10,000-12,000 
per year. 

Although the operation of our 
own shop has effected some savings, 
its most important contribution has 
been its on-the-spot service during a 
time of great change and growth 
throughout the Center. The greatest 
need in this area now is a better work- 
ing space. The entire operation is 
crowded into one small, poorly venti- 
lated basement room. 

The Hospital post office is lo- 
cated near the print shop, employs two 
persons, and is under the same super- 
vision as the print shop. 

Salvatore Caliguri 
Supervisor, Print Shop 



149 



REPORT OF WOMEN'S COMMITTEE 



REPORT OF 
WOMEN'S COMMITTEE 






The Women's Committee of The 
Children's Hospital Medical Center has 
had a busy year. Following the deci- 
sion of the Board of Trustees of The 
Children's Hospital to merge the vari- 
ous units of The Children's Medical 
Center into The Children's Hospital 
Medical Center, at our December 1959 
meeting we voted to change our name 
to the Women's Committee of The 
Children's Hospital Medical Center. 
We invited the entire Staff Wives 
group to join the Women's Commit- 
tee as a standing committee and as in- 
dividual members. This entailed an 
amendment to our by-laws. Before 
this new amendment was passed, the 
number of Active Members had been 
fixed at 125. The chairman of the 
Staff Wives Committee, Mrs. Ran- 
dolph K. Byers, is a member of our 
Executive Committee. 

Two new committees were 
formed this year, the Volunteer Serv- 
ice Committee and the Decorating 
Committee. The Volunteer Service 
Committee, with Mrs. Weston W. 
Adams as chairman, was organized in 
April with representatives of the doc- 
tors, Nursing and Administrative De- 
partments, the director of Volunteer 
Service, a member of the Staff Wives 
group and chairman of the Women's 
Committee as members. Its functions 
are to advise on Volunteer Service and 
to plan the annual Volunteer Party. 
This year's party took place on May 
19 at Gardner House. Dr. Alexander 
S. Nadas of the Cardiology Division 
was the speaker. Volunteer pins were 
awarded. About 175 attended. 

The new Decorating Committee 
consists of three members of the 
Women's Committee, one of them on 
the Executive Board. Mrs. Kirke A. 
Neal is the chairman, assisted by Mrs. 
Frederick R. Weed and Mrs. Joseph T. 
Ryerson, Jr. This year the Hunnewell 
Admitting Entrance was decorated and 



additions were made to the Doctors' 
Lounge. A new project has been the 
hanging of paintings in appropriate 
areas of the hospital. These paintings, 
loaned by the Art Wagon of the In- 
stitute of Contemporary Art, are hang- 
ing in the lobby of the Good Samari- 
tan building and in the Orthopedic 
Out-Patient Waiting Room. 

Many special events kept us busy 
during the year. On February 9 the 
Women's Committee gave a birthday 
party to commemorate the 18 th year 
of the Surgical Dressings group. On 
March 8 the Volunteers and Friends 
meeting took place at the Jimmy Fund 
Building with Dr. Robert J. Haggerty 
as the speaker, assisted by Miss Doro- 
thy Pratt. On July 14 the Stagemobile 
of the Children's Theatre group pre- 
sented the play The Jesters at the 
Jimmy Fund Building, financed by the 
Women's Committee. 

Our Committee contributed in 
various ways to the social activities of 
the Hospital Staff. It was our pleasure 
to provide many special teas. One, re- 
quested by Dr. Lendon Snedeker, on 
October 15 th, entertained the Child 
Study Association of America. An- 
other Tea, on April 11, honored Dr. 
Charles A. Janeway's guest, Dr. Vernon 
Collins of Australia. In September we 
gave a Tea on the Prouty Terrace for 
the Study Group of the International 
Federation of Hospitals. We also co- 
operated in giving a luncheon for the 
wives of this group at the Massachu- 
setts Institute of Technology Faculty 
Club and taking them on a tour of 
Concord. We cooperated with Mrs. 
Kathleen Higgins, Director of Volun- 
teer Service, in entertaining the Coun- 
cil of Directors of Volunteers of 
Greater Boston Hospitals, on Septem- 
ber 20th. These Special Teas were in 
addition to our regular monthly 
Nurses' Teas at Gardner House and 
the weekly Coffees for parents and 



150 



REPORT OF WOMEN'S COMMITTEE 



foreign visitors, held in the Confer- 
ence Dining Room. In July we as- 
sisted at the picnic held at Rivers 
Country Day School for all the house 
staff and their wives and children and 
in September at the third annual pic- 
nic held for the hospital employees. 

In addition to our activities 
within the hospital we attended the 
meetings of the American Hospital 
Association and the Massachusetts 
Hospital Association. In January Mrs. 
Byers and I represented the Women's 
Committee at the Greater Boston Re- 
gional Group of Hospital Auxiliaries, 
at Women's Free Hospital. Monday, 
March 28, was Auxiliary Day at the 
New England Hospital Assembly, 
which Mrs. Robert H. Hopkins, Mrs. 
David Wilder, Mrs. Weston W. 
Adams and I attended. In May the 
Massachusetts Hospital Association 
had a meeting to which Mrs. David 
Wilder, Mrs. Joseph P. Greer and I 
v/ent. In August we were represented 
in San Francisco at the 62nd annual 
meeting of the American Hospital As- 
sociation by Mrs. Joseph P. Greer and 
Mrs. Arthur H. Nelson. 

Our monthly meetings have 
heard a variety of speaker who have 
given their time to keep us up to date 
on hospital activities. In October Mr. 
Joseph P. Greer outlined suggestions 
for our contributions to the Hospital. 
In December Dr. Franc D. Ingraham 
gave us a fascinating talk with slides 
and this was followed by a tour of the 
Neurosurgical Research Laboratory, 
with Dr. Edgar A. Bering, Jr., as guide. 
Dr. Louis K. Diamond spoke to us on 
"Blood Groupings" in January, and 
we toured the new Blood Bank, guided 
by its director, Dr. A. Richardson 
Jones. In February Dr. Adam Sortini 
spoke on "Hearing Problems of Chil- 
dren and Adults." Our Program Meet- 
ing, arranged by the chairmen of our 
various committees, was held in March. 



In April Dr. Robert E. Gross gave us 
a demonstration of his work, assisted 
by Dr. David L. Collins and the head 
anesthetist, Miss Betty E. Lank. It was 
my pleasure to have the May Picnic 
Meeting at my house, and Mr. Joseph 
P. Greer spoke to us there on present 
and future plans of the hospital. 

On the financial side, our dona- 
tion to the hospital totals $32,908. 
Outside community activities, the Daf- 
fodil Club, the Cohasset Music Festival 
and the Cataumet Hospital Week, 
brought in $6,124 of this amount. Our 
own committees, the Lunch Shop, the 
Gift Shop, the Thrift Shop and the 
Yankee Bookstall accounted for 
$22,804, a sum to be proud of. With 
the addition of dues, donations, Re- 
membrance Fund and library contribu- 
tions, we have been able to give 
$5,581 to the Hospital Building Fund, 
$324 to the Social Service Department, 
$3,700 to the Education and Recrea- 
tion Department, $100 to the Whit- 
tington Memorial Fund and $15,000 
for requests from Department Heads. 

Besides diese specific gifts we 
carry on our annual obligations, such 
as salaries, magazine subscriptions, 
Christmas gifts to Hospital Employees, 
Hospital Association dues and travel 
expenses as well as donations of 
flowers and plants throughout the hos- 
pital. 

REPORTS OF THE SUB-COMMITTEES 

Christmas Window Painting — Chair- 
man, Mrs. George H. Sweetnam. Mrs. 
Sweetnam and her Committee of ten 
painters continue enthusiastically 
painting Santas, Rudolphs, etc., all over 
the hospital. They get some of their 
ideas directly from the children them- 
selves. 

Gift Shop — Chairman, Mrs. H. Ray- 
mond Wilkinson. The Gift Shop had 
a wonderful year. A luncheon meeting 
was held at the hospital in November 



for the Gift Shop Chairmen of the 
Massachusetts Hospital Association. 
Mrs. Wilkinson was Chairman of the 
event, assisted by the Gift Shop Volun- 
teers. 

Girl Scouts — Chairman, Mrs. George 
A. Clapp. The Girl Scouts turn in 
scrapbooks, magazines and toys, which 
are much enjoyed by the patients. 

Holiday Committee — Chairman, Mrs. 
Stephen Little. Favors were provided 
for nine holidays during the year. The 
favors were made by Needham and 
Wellesley Girl Scouts and the Boston 
and Weston Junior Red Cross. 

Hospitality Committee — Chairman, 
Mrs. Sidney H. Wirt. At the weekly 
Coffees on Wednesday afternoons in 
the Conference Dining Room, parents 
from twenty-two states and eleven for- 
eign countries were entertained. The 
Lunch Shop provides the food. 

Knitting Committee — Chairman, Mrs. 
Francis A. Harding. A grand total of 
118 articles were knitted for the chil- 
dren by twenty-one faithful knitters, 
plus three Church Groups. A new 
group from Mattapan, called "Chums 
of Children," has been added. Still 
more recruits are needed for the com- 
ing year. 

Library Committee — Chairman, Mrs. 
Kenneth W. Warren. Over 3,000 
books were circulated from the Pa- 
tients' Library on the seventh floor of 
Children's Hospital and over 1,500 
more books from the library of the 
House of the Good Samaritan. A total 
of twenty volunteers staff the libraries 
and the bookcart. In addition to hos- 
pital work, this Committee sent boxes 
of used books to the Ranfurly Out- 
Island Library in the Bahamas and also 
to the Island of Ramea off Newfound- 
land. This year 241 new volumes were 
added to the fine collection of books, 
both foreign and domestic. 



151 



REPORT OF WOMEN'S COMMITTEE 



Membership — Chairman, Mrs. Robert 
H. Hopkins. Mrs. Hopkins reported 
that we have eighty-one new members 
this year, including thirty-five active 
members, twenty-seven sustaining and 
contributing members and nineteen 
associate members. We regret the loss 
of four members, one deceased and 
three resigned. 

Lunch Shop — Chairman, Mrs. Samuel 
S. Stevens. The Lunch Shop continues 
to give excellent service to everyone 
in the hospital. A special feature is 
the policy of extra low prices for chil- 
dren. The Lunch Shop Volunteers 
gave over 7,800 hours of work and the 
sum of $8,000 to the hospital. 

Nurses' Teas — Co-Chairmen, Mrs. 
O. B. B. Rapalyea and Mrs. Richard U. 
Wakeman. Eight teas were held for 
the nurses in Gardner House. The 
Christmas Tea, which included doctors 
as well as other hospital groups, was 
one of the largest we have ever had. 

Photography — Chairman, Mrs. Albert 
H. Hittel. This project continues to 
given pleasure to parents in many 
parts of the world who receive pictures 
of their children taken with our Pola- 
roid Camera. 

Surgical Dressings — Chairman, Mrs. 
Joel M. Barnes. This group has given 
800 hours in the hospital and more 
hours at home. Four Church Groups 
have helped, and a remarkable total of 
over 162,000 dressings have been 
made for the hospital. 

Thrift Shop — Chairman, Mrs. David 
Wilder. Receipts increased slightly to 
$3,834 but so did the expenses; there- 
fore the net profit was slightly lower 
than last year, $2,187. More donations 
are needed and a bundle should be 
brought to each meeting. 

Staff Wives Committee — Chairman, 
Mrs. Randolph K. Byers. This com- 



mittee, organized in 1952, operated in- 
dependently until January, I960, when 
it joined the Women's Committee as 
a standing committee and its members 
joined individually. Their activities 
included a tea at Mrs. John Enders' 
house for new house staff in January, 
two morning parties at the house of 
Mrs. Harry Shwachman in July and a 
fall dance in November. 

Volunteer Service Committee — Chair- 
man, Mrs. Weston W. Adams. This 
newest standing committee of the 
Women's Committee was organized 
last spring to act as a liaison between 
the professional services of the staff of 
the hospital and its volunteers. It 
hopes to be of assistance in solving 
problems of placement and in recruit- 
ing volunteers. The committee or- 
ganized and helped to run the Volun- 
teer Party in May. 

Yankee Bookstall — Chairman, Mrs. 
Alfred Thomas. The proceeds of the 
sale of $5,581 were given to the Hos- 
pital Building Fund. Massachusetts 
Horticultural Hall has proved to be a 
convenient place for the sale, and it 
will be held there this April 6 through 
April 11. 

REPORTS FROM OTHER UNITS 

Children's Mission to Children — Mrs. 
Alexander S. Nadas. A new project of 
this unit is consultation service to the 
Child Health Unit of Children's Hos- 
pital in addition to its regular activi- 
ties of foster home placement and the 
parent guidance. 

House of The Good Samaritan — Miss 
Margaret A. Revere. On January 1, 
1961, the House of the Good Samari- 
tan celebrated its 100th anniversary. 
This unit now houses the Respirator 
Unit, the Heart Clinic and the Rheu- 
matic Fever cases and convalescent 
children. The photocardiograph ma- 



chine donated by the Women's Com- 
mittee this year will be very useful. 

Infants' Hospital — Mrs. Charles F. 
Hovey. Miss Gladys Beardwood, head 
nurse of the Infants' Hospital, and 
Mrs. Carolyn Overfors, head nurse of 
the Premature Nursery, reported the 
hospital has been filled to capacity. 
The Women's Committee magazines 
are enjoyed in the waiting rooms, and 
the Baby Tendas are much appre- 
ciated. 

These many activities could not 
be carried on without the help of all 
our members, most especially the hard- 
working chairmen of the various com- 
mittees and the efficient members of 
the Executive Committee. To all I 
want to express my heartfelt gratitude 
for the support and cooperation they 
have given me during my three years 
in office. It has been stimulating, in- 
teresting to work with them all. My 
very special thanks go to Miss Dorothy 
Rutherford, who has been a bulwark of 
strength. It has been a great privilege 
and a wonderful experience to serve 
you as Chairman and through the com- 
mittee to serve this truly great Chil- 
dren's Hospital Medical Center. 

Mrs. Charles F. Hovey 
Chairman, Women's Committee 



152 



REPORT OF WOMEN'S COMMITTEE 



FINANCE COMMITTEE REPORT 



At the Annual Meeting of the Women's Committee on November 15, the Finance 
Committee presented the following recommendations for funds to be voted: 



Proceeds (Yankee Bookstall) to 
Building Fund of the Hospital 

Women's Committee Obligations 
Recreation Services 
Teas and Entertainment 
Knitting Committee 
Library Committee 
Holiday Committee 
Flower Fund 
Discretionary Fund 

Received from Remembrance Fund 
(Paid to Hospital Social Service) 



600.00 
1,500.00 
100.00 
250.00 
100.00 
200.00 
150.00 



>,581.29 



2,900.00 



324.00 



Items for Contribution 

Hi-Fidelity Record Player 75.00 

Prisma Glasses 100.00 

Baby Tendas 50.00 

Recreation — Towards Salaries & Play Equipment 5,500.00 

Kitchenette & Small Lounge — 19 Peabody Street 1,500.00 

Funds for Tickets— Student Nurses ($250) 700.00 

House Staff ($450) 

Tape Recorder for X-Ray Therapy Area 250.00 

Television Sets — Purchasing New & Replacing 3,000.00 

Scholarship Fund — Nurses 1,500.00 
Conference Dining Room — Cupboards, Sink & Hotplate 1,000.00 

Staff Wives Committee— Fall Dance 500.00 

Hospital Picnics — House Staff & Employees 500.00 

Flower Fund— Additional for 1961 100.00 

Discretionary Fund — Additional for 1961 100.00 

Hospital Bowling League 125.00 



Total 



15,000.00 
$23,805.29 



Mrs. George P. Buell, Chairman 

Mrs. Stewart H. Clifford 

Mrs. Roger A. Perry 



153 



REPORT OF WOMEN'S COMMITTEE 



ACTIVE MEMBERS 

Adams, Mrs. Weston W. 
Alden, Mrs. John M. 
Allen, Mrs. W. Lloyd 
Almy, Mrs. Robert B. 
Almy, Mrs. Robert B. 
Anthony, Mrs. Carroll G. 

Bainbridge, Mrs. Robert P. 
Barnes, Mrs. Joel M. 
Bartlett, Mrs. Charles W. 
Batchelder, Mrs. Charles F. 
Bering, Mrs. Edgar A., Jr. 
Bigelow, Mrs. Edward L., Jr. 
Brewer, Mrs. Cyrus 
Brickley, Mrs. Philip E. 
Buell, Mrs. George P. 
Bursk, Mrs. Edward C. 
Burwell, Mrs. C Sidney 
Byers, Mrs. Randolph K. 
Berenberg, Mrs. William 

Carney, Miss Dorothy M. 
Clapp, Mrs. Eugene H., II 
Clifford, Mrs. Stewart H. 
Coburn, Miss Louise 
Crandell, Mrs. John C, Jr. 
Crigler, Mrs. John F., Jr. 
Crockett, Mrs. Charles B. 

Dale, Mrs. John 
Damon, Mrs. Lawrence B. 
Diamond, Mrs. Louis K. 
Drorbaugh, Mrs. James E. 
Drury, Mrs. Samuel S. 
Dyer, Mrs. Edwin C. 

Elliott, Mrs. Byron K. 
Emerson, Mrs. Edward L. 
Emery, Mrs. Forrest S. 
Erickson, Mrs. Joseph A. 

Ferguson, Mrs. Charles F. 
Flood, Mrs. Richard T. 
Floyd, Mrs. Richard C. 
Foster, Mrs. Reginald, Jr. 
French, Mrs. Stanley G. 

Gerrity, Mrs. Frank 
Gettings, Mrs. James H. 
Gibby, Mrs. Harry 
Gillette, Mrs. Howard F. 
Good, Mrs. Arthur J. 
Greer, Mrs. Joseph P. 

Haffenreffer, Mrs. Theodore 
Haggerty, Mrs. Robert J. 
Hansel, Mrs. Lawrence H. 
Harding, Mrs. Donald F. 
Harding, Mrs. Francis A. 
Harwood, Mrs. Bartlett, Jr. 



Hebbard, Mrs. William E. 
Hendren, Mrs. W. Hardy. 
Hopkins, Mrs. Robert H. 
Hornblower, Mrs. Henry, II. 
Hovey, Mrs. Charles F., 
Hunnewell, Mrs. Walter, Jr. 
Hurlbut, Mrs. Cornelius, Jr. 

Johnson, Mrs. John H. 
Johnson, Mrs. Laurence H. H. 

Karp, Mrs. Meier 
Kennard, Mrs. Robert M. P. 
Kieran, Mrs. John 
Kiley, Mrs. John G, Jr. 
Knight, Mrs. Richard C. 
Knowles, Mrs. John H. 
Kroto, Mrs. Hans, 

Lanman, Mrs. Thomas H.. 
Latham, Mrs. Earle O. 
Leland, Miss Elizabeth C. 
Levin, Mrs. Benjamin 
Liebman, Mrs. Sumner 
Little, Mrs. Stephen 
Lombroso, Mrs. Cesare T. 
Lowe, Mrs. Samuel L., Jr. 
Lyman, Mrs. Ronald T., Jr. 

Mercer, Mrs. Douglas, Jr. 
Mitchell, Mrs. Emlyn V. 
Munro, Mrs. Edward S.. 
Murphy, Mrs. Edward L. 
Mueller, Mrs. Harry L. 

Nadas, Mrs. Alexander S. 
Nelson, Mrs. Arthur H. 
Nordbeck, Mrs. Theodore E. 

Ober, Mrs. Frederick C. 

Paige, Mrs. Francis A. 
Paine, Mrs. Richmond S. 
Painter, Mrs. Whitfield 
Palmer, Mrs. Henry W. 
Parker, Mrs. James F. 
Parsons, Mrs. Ernst, 
Perry, Mrs. Roger A. 
Petremont, Mrs. Dorothy P. 
Pettit, Mrs. Charles H. 
Pfeffer, Mrs. William 
Pollock, Mrs. Robert J. 
Pratt, Mrs. Albert 
Potter, Mrs. Gary 

Rapalyea, Mrs. Oldfield B. B. 
Revere, Miss Margaret A. 
Riley, Mrs. Russell F. 
Robb, Mrs. Walter E., Jr. 
Rogers, Miss Dorothy 
Russell, Mrs. Otis T. 



Ryerson, Mrs. Joseph T., Jr. 

Sawyer, Mrs. Henry B. 
Scott, Mrs. J. Gordon 
Sears, Mrs. Richard D. 
Smith, Mrs. Everett W. 
Smith, Mrs. Robert M. 
Steele, Mrs. Keith C. 
Stevens, Mrs. Samuel S. 
Stewart, Mrs. Frank H. 
Summers, Mrs. Merle G. 
Sutton, Mrs. Gardner 
Sweetnam, Mrs. George H. 
Sylvester, Mrs. Albert I. 

Tappan, Mrs. Robert A. 
Thayer, Mrs. Sherman R. 
Thomas, Mrs. Alfred 
Thompson, Mrs. George E. 

Wakeman, Mrs. Richard V. 
Walker, Mrs. Rufus F. 
Wallace, Mrs. Jacob 
Walworth, Mrs. Gardner C. 
Warren, Mrs. Kenneth W. 
Weed, Mrs. Frederick R. 
Welch, Mrs. Hillard W. 
Wellington, Mrs. Stephen B. 
Wetherald, Miss Dorothy P.. 
Whittemore, Mrs. Robert M. 
Wilder, Mrs. David 
Wilkinson, Mrs. H. Raymond 
Williams, Mrs. Barrett 
Williams, Mrs. Willis E. 
Wilson, Mrs. Samuel T. 
Winter, Mrs. William D, Jr. 
Wirt, Mrs. Sidney H. 
Wolcott, Mrs. Samuel H.